Intestinal Malrotation in Adults: A case series and Literature Review

Abstract Aim Midgut malrotation is a rare but a very well-known congenital anomaly. It is a result of non-rotation, incomplete rotation or reversed rotation and fixation of midgut. Delayed diagnosis due to non-specific symptoms in elective cases and conversion to laparotomy due lack of intra-operative anatomical understanding in emergency cases imposes increase in patient dis-satisfaction, delayed recovery and healthcare cost burden. Here we report an interesting case series which impose a significant diagnostic challenge due to atypical clinical and radiological signs. Management of such cases by minimal invasive surgery is possible if general surgeons are aware of unusual anatomy and general practitioners are aware of such known but rare cases. Cases Two patients who presented on background of on and off recurrent non-specific attacks of abdominal pain, one of them as an emergency as midgut volvulus, were diagnosed radiologically and treated laparoscopically. The other one presented as an acute appendicitis and was converted to laparotomy, in spite of good laparoscopic expertise due to lack intra-operative anatomical understanding. Conclusion In the era of laparoscopic surgery, a general surgeon should encounter such an unusual case once in a lifetime. It is of paramount importance to be well verse with such unusual cases. General Practitioners should be aware of such atypical presentations of rare conditions causing recurrent abdominal pain. They should consider appropriate further imaging investigations and referrals for best possible patient care.