Intestinal malrotation is a rare congenital anomaly that typically presents during infancy; adult presentations are uncommon and often manifest with vague, chronic gastrointestinal (GI) symptoms. We report a unique case of a woman in her 30s who presented with acute bilious vomiting, severe malnutrition and a 2-year history of post-prandial vomiting and weight loss. Imaging revealed high-grade distal duodenal obstruction, mesenteric swirling and an absent right colon. Laparoscopic exploration demonstrated Ladd's band duodenal obstruction, pre-superior mesenteric artery (SMA) malrotation or non-rotation with concomitant post-SMA reverse rotation and a separate bowel segment involved in a chronic midgut volvulus through an internal hernia defect - a combination not previously described. A laparoscopic Ladd's procedure with internal hernia reduction was carried out. Laparoscopic management of complex cases of intestinal malrotation is feasible. Clinicians should maintain a high index of suspicion for congenital anomalies in adults who present with duodenal obstruction or recurrent, unexplained GI symptoms.
Varama et al. (Mon,) studied this question.
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