Abstract Congenital intestinal malrotation is a rare developmental anomaly that typically presents during childhood but may remain undiagnosed until adulthood, when symptoms can arise abruptly due to volvulus or intestinal ischemia. We report the case of a 33-year-old woman, previously healthy, who presented with acute abdominal pain, abdominal distension, and peritoneal signs. Laboratory tests revealed mild neutrophilic leukocytosis. Abdominal computed tomography with oral Gastrografin demonstrated marked gastric distension and mesenteric swirling, initially suggestive of intestinal volvulus. Urgent surgical exploration revealed congenital intestinal malrotation with abnormal positioning of bowel loops and a volvulated ileal segment showing vascular congestion and early ischemic changes. Derotation and careful assessment of bowel viability were performed; due to persistent ischemic changes, resection of the compromised ileal segment with primary mechanical anastomosis was required. Postoperative recovery was uneventful. This case highlights the diagnostic challenges of intestinal malrotation in adults, where clinical presentation is often nonspecific and radiologic findings may be misleading. Early surgical intervention remains essential to prevent irreversible ischemic injury and bowel necrosis.
Pellegrino et al. (Thu,) studied this question.