Siddiqui Muhammad Umer Farooq, Saeed Mahnoor, Khattak Muhammad Naeem, Khan Aamir
General Surgery, Khyber Teaching Hospital, Khyber Medical College, Peshawar, PAK.
Cureus. 2025 Jun 29;17(6):e86981. doi: 10.7759/cureus.86981. eCollection 2025 Jun.
Intestinal malrotation is a congenital anomaly with mostly reported cases in neonates, although, in adults, limited cases have been reported in the literature. However, in adults, prompt recognition is of utmost importance to prevent drastic complications like bowel ischemia and death. We present a rare case of coexistence of congenital intestinal malrotation and jejunal diverticula presenting as a volvulus. We present a case of a 78-year-old male with no comorbidities presenting to the emergency department with an acute abdomen, diagnosed as a case of intestinal obstruction in a virgin abdomen, and treated conservatively. Meanwhile, CT abdomen and pelvis showed volvulus of the small intestine, so the patient was taken for exploratory laparotomy, which revealed the small bowel rotation with a high cecum and a narrow mesentery. Ladd's procedure was performed without any perioperative complications. Few reports of congenital intestinal malrotation in the elderly are presented in the literature. This highlights the importance of evaluating all patients for malrotation if presenting in elderly patients with a virgin acute abdomen to prevent complications like bowel ischemia. Elderly patients presenting with acute intestinal obstruction, if not improving conservatively, should make the clinician think about congenital intestinal malrotation as a differential diagnosis as well, among all other common causes.
肠旋转不良是一种先天性异常，大多报道的病例发生在新生儿中，不过，在成人中，文献报道的病例有限。然而，对于成人来说，迅速识别对于预防诸如肠缺血和死亡等严重并发症至关重要。我们报告一例罕见的先天性肠旋转不良与空肠憩室并存并表现为肠扭转的病例。我们报告一例78岁男性，无合并症，因急腹症就诊于急诊科，初诊为无既往腹部手术史的肠梗阻，予以保守治疗。同时，腹部和盆腔CT显示小肠扭转，因此患者接受了剖腹探查术，术中发现小肠旋转、盲肠高位和肠系膜狭窄。实施了Ladd手术，未发生任何围手术期并发症。文献中很少有关于老年人先天性肠旋转不良的报道。这凸显了对于所有初发急腹症的老年患者评估是否存在旋转不良的重要性，以预防诸如肠缺血等并发症。老年患者出现急性肠梗阻，如果保守治疗无效，临床医生在考虑所有其他常见病因时，也应将先天性肠旋转不良作为鉴别诊断之一。
