Krstic Daniel, Chatziisaak Dimitrios, Konstantinović Strahinja, Benigno Luca, Soll Christopher, Biraima Magdalena
Department of Surgery, Hospital GZO Wetzikon, Wetzikon, Switzerland.
Department of Visceral Surgery, Hospital of the Canton of St. Gallen, St. Gallen, Switzerland.
Am J Case Rep. 2025 Jul 13;26:e949194. doi: 10.12659/AJCR.949194.
BACKGROUND Intestinal malrotation (IM) is a rare congenital anomaly resulting from incomplete midgut rotation during embryonic development. Typically, it is diagnosed in infancy due to symptoms such as bilious vomiting, failure to thrive, or signs of bowel obstruction. However, in some cases, it remains undetected until adulthood, when it can present either incidentally or with complications, including volvulus, chronic abdominal pain, or acute bowel obstruction. Although its exact incidence in adults is unclear, studies estimate it to be approximately 0.2% to 0.5%, underscoring its rarity in this age group. As such, adult cases of IM pose a diagnostic challenge and are often discovered unexpectedly during imaging or surgery for unrelated conditions. CASE REPORT A 20-year-old woman with no medical history was admitted to our hospital with persistent mid-abdominal pain. Clinical and sonographic findings suggested acute appendicitis; however, intraoperative exploration revealed an unexpected intestinal malrotation of the non-rotation type. The cecum was in the midline, and the colon was entirely positioned in the left hemi-abdomen, which rendered laparoscopic appendectomy technically challenging. The operation was successfully completed without the need for an additional procedure to correct the malrotation. The postoperative course was uneventful, and the patient was discharged on the second postoperative day in good condition. CONCLUSIONS This case highlights the importance of considering congenital anomalies such as IM in cases of atypically located abdominal structures. Awareness of such anatomical variations is crucial for surgeons so they can adapt intraoperative strategies accordingly and ensure optimal patient outcomes.
肠旋转不良（IM）是一种罕见的先天性异常，由胚胎发育过程中中肠旋转不完全引起。通常，由于胆汁性呕吐、生长发育迟缓或肠梗阻体征等症状，该病在婴儿期被诊断出来。然而，在某些情况下，直到成年才被发现，此时可能偶然出现或伴有并发症，包括肠扭转、慢性腹痛或急性肠梗阻。尽管其在成人中的确切发病率尚不清楚，但研究估计约为0.2%至0.5%，这突出了其在该年龄组中的罕见性。因此，成人IM病例构成了诊断挑战，并且常常在因无关病症进行影像学检查或手术期间意外发现。病例报告：一名无病史的20岁女性因持续性中腹部疼痛入住我院。临床和超声检查结果提示急性阑尾炎；然而，术中探查发现了意外的非旋转型肠旋转不良。盲肠位于中线，结肠完全位于左半腹，这使得腹腔镜阑尾切除术在技术上具有挑战性。手术成功完成，无需额外进行纠正旋转不良的操作。术后病程顺利，患者术后第二天状况良好出院。结论：本病例强调了在腹部结构位置不典型的病例中考虑IM等先天性异常的重要性。了解此类解剖变异对外科医生至关重要，这样他们就可以相应地调整术中策略并确保患者获得最佳预后。
