Caecal volvulus around a Ladd's band in undiagnosed adult malrotation

We report a rare case of cecal volvulus around Ladd's band in a 45-year-old woman with previously undetected intestinal malrotation despite two prior laparotomies. The patient presented with subocclusive bowel syndrome and underwent emergency surgical exploration after computed tomography demonstrated cecal volvulus with pneumatosis intestinalis and intraperitoneal fluid. Intraoperative findings revealed incomplete common mesentery with small bowel positioned entirely on the right and colon on the left. Remarkably, the cecum had volvulated around a Ladd's band serving as the primary torsion axis, rather than the typical mesenteric pedicle. Right hemicolectomy with ileocolic anastomosis was performed. This case highlights several important teaching points: the potential for congenital anomalies to escape detection during prior surgeries, the atypical mechanism of volvulus around Ladd's band, diagnostic challenges despite advanced imaging, and ongoing controversies in surgical management of adult malrotation presenting with acute complications.