Intestinal Malrotation in Adulthood with Non-Ischemic Midgut Volvulus: A Case Report

Background: Congenital intestinal malrotation diagnosed in adulthood is rare, hence is more often an incidental diagnosis. We report in our paper a case of young adult with chronic small gut malposition complicated with midgut volvulus without arterial compromise. Methods: We report the case of a 22-years old female with no past history admitted for chronic sub-occlusive syndrome and portal hypertension. Physical examination assessed a mild abdominal distension with ascites and a BMI of 16 kg /m2. Endoscopic exploration was non-specific. Abdominal entero-CT scan confirmed jejunal malposition with mesenteric hyperemia and parietal venous stasis. Further exploration confirmed malabsorptive disorders and malnutrition. Decision was made favoring coelioscopic evaluation first. We converted to laparotomy for extended exploration and appropriate management. We carried on adhesiolysis of the jejunum, retrograde bowel emptying, small bowel unfolding and finally fixation of the last jejunal loop with its mesenteric root. Post-operative evolution was uneventful. Discussion: Congenital intestinal malrotation is considered a spectrum of rotational anomalies; as such it holds a high clinical multigenicity. Moreover considering difficulty of diagnosis, high number of subtypes, and consequent possible complications, there is no standard of care regarding treatment of intestinal malrotation. We carried laparoscopic exploration followed by laparotomy un-conventional Ladd's surgery. Finally, our case report manifests the possible repercussions of delayed treatment such as severe malnutrition. Conclusion: Small bowel malrotation carry a significant risk of complication, including midgut rotation. Our paper shows downfalls of chronic midgut volvulus that are essentially malabsorptive complications, associated with serious decline of quality of life. Therefore surgical treatment is both inevitable and effective.