Chronic gastrointestinal symptoms in adulthood revealing congenital intestinal malrotation with midgut volvulus: a...

Intestinal malrotation is a congenital anomaly of midgut rotation and fixation that typically manifests in infancy, with most cases diagnosed within the first year of life. Although rare, accounting for ~0.2%-0.5% of all malrotation cases, intestinal malrotation can present in adults, with nonspecific symptoms that may delay diagnosis. We report the case of a 48-year-old male with a four-year history of recurrent colicky abdominal pain and non-bilious vomiting that progressively worsened over the preceding three months, with vomiting increasing to nearly ten episodes daily. A contrast-enhanced abdominal computed tomography demonstrated marked dilatation of the proximal duodenum with a transition point at the mid-duodenum suggestive of a partial obstruction. Upper gastrointestinal fluoroscopy confirmed midgut malrotation with an incomplete volvulus. The patient subsequently underwent a Ladd procedure. Adult midgut malrotation should be considered in patients with chronic, unexplained abdominal pain and vomiting. Early diagnosis is essential to prevent life-threatening complications such as a volvulus and bowel ischemia.