Laparoscopic Ladd surgery in adult with chronic intestinal obstruction due to midgut malrotation

Symptomatic congenital intestinal malrotation during adulthood is a rare condition usually presented as a chronic clinical condition superimposable to an upper intestinal obstruction. Symptoms tend to be nonspecific, varying from intermittent episodes of vomiting, food intolerance, and weight loss, leading to a delayed diagnosis worsening the patient’s functional reserve. High clinical suspicion leads to the request of the request of requesting adequate diagnostic imaging, with computerized tomography being the imaging of choice. While Ladd surgery is the standard of care, the approach is controversial with a tendency for minimal invasive surgery due to faster postoperative recovery, better pain management, and shorter hospital stays. A case of female patient in her 80s is presented with 6 months symptoms of vomiting and weight loss. Computed tomography scan diagnosed an upper intestinal obstruction due to intestinal malrotation. Intraoperative findings showcased a duodenojejunal junction stenosis due to the presence of Ladd bands. Ladd surgery was performed without concomitant appendicectomy.