Midgut Volvulus Secondary to Intestinal Malrotation in Adult Male: A Case Report and Mini Review

Abstract

Intestinal malrotation is a congenital anomaly that occurs due to abnormal rotation and fixation of the intestine when it returns to the abdominal cavity during fatal development. There have been only 92 documented cases of this condition in medical literature. The incidence of malrotation is approximately 1 in 6,000 live births. Most malrotation cases, about 60-80%, become evident in the first month of life, with 90% being diagnosed within the first year. Adult presentations of malrotation are exceedingly rare, accounting for only 0.2 to 0.5% of cases, and among these, only 15% present with midgut volvulus. The incidence of midgut malrotation in adults has been reported to be between 0.00011 and 0.19%. Most diagnoses of midgut malrotation in adults occur in asymptomatic patients, often through imaging investigations or incidental findings during surgeries for other medical issues. Diagnosis of midgut volvulus is primarily established through various methods, with CT abdomen being the most common (67%), followed by ultrasonography (15%), and during exploratory laparotomy (18%). It's important to note that midgut volvulus is associated with a high risk of bowel ischemia and necrosis, as it affects the blood supply to the intestines through the mesenteric artery, resulting in a significant 5% mortality rate. We are reporting an unusual case involving a 20-year-old male who was found to have midgut volvulus affecting his jejunum and small bowel. This condition was a consequence of congenital malrotation of the bowel. The patient underwent an exploratory laparotomy, during which the volvulus was corrected by detorsion, inter-mesenteric bands adhesiolysis, and an appendectomy was performed.