Acute Cecal Volvulus in an Adult With Intestinal Malrotation: A Case Report and Surgical Considerations

Cecal volvulus is an uncommon cause of intestinal obstruction that may present diagnostic and therapeutic challenges, particularly in adults with intestinal malrotation.We report the case of a 47-year-old male patient who presented with generalized abdominal pain, bilious vomiting, obstipation, and marked abdominal distension.Initial imaging was interpreted as severe coprostasis and intestinal distension.Following unsuccessful conservative management and clinical deterioration, reassessment of abdominopelvic computed tomography (CT) revealed marked cecal dilation and displacement into the left paracolic gutter, associated with proximal small bowel dilation and distal colonic decompression.Emergency exploratory laparotomy demonstrated a 360-degree cecal volvulus, abnormal colonic fixation and configuration consistent with intestinal malrotation, transmural necrosis of the cecum and proximal ascending colon, and dense intra-abdominal adhesions.Cecectomy, closure of the distal colonic stump, and Brooke-type end ileostomy were performed because of macroscopic bowel gangrene and intra-abdominal contamination.The patient remained clinically stable during the documented postoperative period, with a viable and functioning ileostomy.This case highlights the importance of careful CT assessment, recognition of abnormal intestinal anatomy, and individualized surgical management according to intraoperative macroscopic viability and findings.