Reversed intestinal malrotation with volvulus in an adult: A case report

Congenital intestinal malrotation is a rare developmental anomaly of midgut rotation and fixation, with an estimated incidence of 0.2-0.5% in the adult population. Reversed intestinal rotation represents the rarest variant, accounting for approximately 2-4% of all malrotation cases, and is frequently associated with delayed diagnosis due to nonspecific symptoms. We report the case of a 45-year-old woman with long-standing gastrointestinal symptoms who presented with subocclusive features. Contrast-enhanced multiphasic computed tomography revealed reversed intestinal malrotation complicated by ileocecal volvulus, characterized by abnormal positioning of the bowel, inversion of the superior mesenteric vessels and a typical whirlpool sign. Surgical exploration via midline laparotomy confirmed the imaging findings, including Ladd's band and increased cecal mobility. A Ladd procedure was performed, consisting of division of fibrous bands, derotation of the bowel, widening of the mesenteric base and appendectomy. The postoperative course was uneventful, with complete resolution of symptoms. This case highlights the essential role of cross-sectional imaging in establishing early diagnosis and guiding timely surgical management to prevent life-threatening complications.