Midgut malrotation with volvulus and appendicular agenesis in a young adult woman: a rare case report

Introduction: Midgut volvulus secondary to intestinal malrotation is a rare cause of acute abdomen in adults. Appendicular agenesis is an exceptionally uncommon congenital anomaly, and its coexistence is exceedingly rare. Case presentation: An 18-year-old woman presented with acute-on-chronic abdominal pain, nausea, and vomiting, with a long history of recurrent gastrointestinal symptoms. A contrast-enhanced computed tomography revealed a whirlpool sign suggestive of midgut volvulus. Exploratory laparotomy demonstrated a 540° clockwise midgut volvulus, type I (non-rotation) intestinal malrotation with Ladd’s bands, a high-riding cecum, and congenital absence of the vermiform appendix. A standard Ladd’s procedure was performed, excluding appendectomy. Discussion: Adult intestinal malrotation often presents with vague, nonspecific symptoms, leading to diagnostic delay. A shortened mesenteric root predisposes to midgut volvulus, a potentially life-threatening complication. Appendicular agenesis should be considered when the appendix cannot be identified despite meticulous exploration. Conclusion: This case highlights a rare association of adult midgut volvulus with appendicular agenesis. Early imaging, high clinical suspicion, and prompt surgical intervention are essential for optimal outcomes.