A Rare Case of Adult Symptomatic Intestinal Malrotation Treated with Laparoscopic Ladd Procedure: Case Report

Background: Intestinal malrotation is a congenital condition caused by incomplete or absent rotation of the intestine around the superior mesenteric artery during embryonic development. It is typically presents in the neonatal period. In adults, it is rare (0.2%) and often asymptomatic, discovered incidentally during exams or surgeries. The clinical context in an adult patient can cause chronic symptoms such as intermittent abdominal pain, dyspepsia, nausea, vomiting and abdominal swelling. Diagnosis is best achieved with an upper gastrointestinal contrast study, while CT scan or MRI may detect it incidentally. Surgical correction (Ladd’s procedure) involves reducing volvulus (if present), removing Ladd's bands, and broadening the mesenteric base. This case is noteworthy due to the limited number of similar reports documented globally. Case Presentation: A 67-year-old woman presented with a 4-month history of weight loss, loss of appetite, and episodes of abdominal pain. An abdominal CT revealed signs of intestinal malrotation, and an MRI confirmed these findings, showing abnormal positioning of intestinal loops and vascular structures. Exploratory laparoscopy was performed, and intraoperative findings confirmed the diagnosis. The entire adhered right colon was released from the sigmoid at the angle of Treitz and was repositioned to the right side of the abdomen with the cecum. The patient recovered well, was discharged on the second postoperative day, and remained asymptomatic during follow-up visits at 8 days, 45 days, 3 months post-surgery and ten years after. Discussion and Conclusion: Identifying intestinal malrotation in adults is challenging because of the broad range and vague nature of the symptoms. Diagnostic delays can result in serious complications and less favorable surgical outcomes. Treatment depends on symptomatology and intraoperative findings. Ladd’s Procedure remains the standard approach, involving repositioning of the intestines and release of abnormal bands. The patient in question underwent successful laparoscopic correction, with complete symptom resolution and no complications during follow-up.