Laparoscopic Ladd procedure for adult-onset intestinal malrotation with midgut volvulus: a case report

Intestinal malrotation is a rare congenital anomaly resulting from the incomplete rotation of the midgut. While commonly diagnosed in newborns, adult presentation is extremely rare (0.2-0.5%), making its true incidence unknown. This case report describes a rare adult-onset midgut volvulus successfully managed via a minimally invasive approach.

A 29-year-old female presented to the emergency department (ED) with acute abdominal pain, nausea, and a history in the last two years of intermittent, self-limiting subocclusive episodes. Abdominal computed tomography (CT) revealed an extensive midgut volvulus along the mesenteric axis without signs of ischemia. Given the high risk of visceral complications, an urgent exploratory laparoscopy was performed. Surgical interventions consisted in the Ladd procedure, including retrograde intestinal derotation, division of Ladd's bands, extensive adhesiolysis, prophylactic appendectomy, and bowel repositioning. The postoperative course was uneventful; the patient tolerated early oral intake and was discharged after 4 days. At 3-month follow-up, a second CT scan confirmed the resolution of the volvulus, and the patient reported complete relief from symptoms of obstruction.

Ladd procedure is a safe, feasible, and effective treatment for adult intestinal malrotation complicated by volvulus. A minimally invasive approach can be considered a viable alternative to open surgery in selected adult patients with non-complicated twisted bowel.