Management of midgut volvulus in an incomplete common mesentery in a 17-year-old patient: a case report and literature review

Introduction and importance: Intestinal malrotation encompasses a spectrum of congenital anomalies resulting from incomplete rotation and fixation of the midgut during embryogenesis. Incomplete common mesentery is the most common form encountered in adulthood and is associated with a narrow mesenteric base, predisposing patients to midgut volvulus due to abnormal peritoneal attachments (Ladd’s bands). Case presentation: A 17-year-old patient presented to the emergency department with acute abdominal pain and an initial diagnosis of cecal volvulus. Exploratory laparotomy revealed severe mesenteric ischemia involving the entire small bowel due to a midgut volvulus, secondary to an incomplete common mesentery. A Ladd procedure was performed using a damage-control approach, resulting in complete resolution of bowel ischemia. Definitive abdominal wall closure was achieved on postoperative day 2. Clinical discussion: Although rare in adolescents and adults, intestinal malrotation should be considered in the differential diagnosis of acute abdominal pain. Radiologic findings may be misleading and delay diagnosis. Prompt surgical intervention with a Ladd procedure can restore bowel perfusion and prevent catastrophic outcomes. A staged damage-control strategy is particularly useful when bowel viability is uncertain. Conclusion: This case highlights the diagnostic challenges of intestinal malrotation in older patients and underscores the importance of accurate imaging interpretation and timely surgical management.