An Unusual Case of Thyroid Storm Masquerading as an Intestinal Obstruction in a Patient With Malrotation of the Gut

Gut malrotation is usually a pediatric condition that presents mainly in the first month of life. It rarely presents in adults and is often a significant diagnostic dilemma to the surgeon. Failure to diagnose and treat this condition early may result in dire consequences like small gut gangrene. A previously healthy, 41-year-old female patient presented to the emergency department with a three-day history of lower abdominal pain and constipation. On examination, she had tachycardia, and her abdominal examination was soft, with mild tenderness in the hypogastric region and scanty bowel sounds. Urine pregnancy and dipstick were unremarkable. The patient was diagnosed with small bowel obstruction (malrotation of the small bowel loops with twisting of the mesenteric vessels). The patient was found to have thyrotoxicosis, which was the cause of the intestinal obstruction. She received conservative treatment and specific thyrotoxicosis management (carbimazole, cholestyramine, Lugol’s iodine, and intravenous hydrocortisone). The symptoms resolved entirely after a two-day stay at the intensive care unit. Small bowel malrotation is a congenital anomaly and can present with abdominal pain and obstruction in adulthood. Thyrotoxicosis can cause small bowel obstruction if there is underlying malrotation.