An Unusual Case of Intestinal Malrotation Causing Duodenal Obstruction by a Looped Appendix

Patient: Male, 30 Final Diagnosis: Duodenal obstruction caused by a looped appendix due to intestinal malrotation Symptoms: Post postprandial vomiting Medication: — Clinical Procedure: Improved after unwinding of the looped appendix and subsequent appendectomy Specialty: Surgery OBJECTIVE: Congenital defects/diseases BACKGROUND: Bowel obstruction is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Intestinal malrotation is one of the rarest causes of mechanical bowel obstruction. In adults, the incidence rate is 0.2%, and 15% of all patients with confirmed diagnosis remain asymptomatic throughout life. Surgery is generally required when the patient is symptomatic. CASE REPORT: A 30-year-old man with multiple admissions for chronic intermittent colicky abdominal pain since childhood, was admitted for symptoms suggestive of proximal small bowel obstruction. Tomographic imaging identified a midgut malrotation and a duodenal obstruction by a non-diseased displaced appendix. Laparoscopic liberation of the duodenum and the terminal ilium was done successfully. CONCLUSIONS: Intestinal malrotation is infrequently encountered in the adult population, but it should be kept in mind as a differential diagnosis whenever a case of acute intestinal obstruction in an adult presents without any significant past surgical history.