INTRODUCTION: Intestinal malrotation is a clinical surgical entity that is present in the everyday practice of the pediatric surgeon. However, it becomes a diagnostic challenge when symptoms develop in adolescents and adults. CASE REPORT: A woman presented to the hospital with intense abdominal pain of three days' duration and progressive worsening over the preceding 24 hours. The pain increased markedly after meals, accompanied by nausea and vomiting. On physical examination, the patient was in good general health, her abdomen was flat, flaccid, with normal bowel sounds, and tender to palpation of the epigastrium, yet with no signs of peritoneal irritation. Laboratory test results were within the limits of normal, as was ultrasonography. No clinical improvement was achieved despite the treatment instituted; surgical exploration was chosen as tomography was suggestive of intestinal malrotation. Intraoperatively, all the small intestine was found to be positioned to the right side of the abdomen and the colon, to the left side. In addition, the proximal jejunum was ischemic and forming a volvulus of 720º over the axis of the superior mesenteric vessels. In order to correct the anomaly, enterotomy of the proximal jejunum was performed at approximately 10 cm from the ligament of Treitz, and the volvulus was corrected. This promoted a progressive improvement of the intestinal ischemia, which made enteroanastomosis possible. The middle colic artery pedicle was ligated at its root and a right colectomy was performed, followed by a side-to-side ileo-transverse anastomosis. The patient is doing well. CONCLUSION: Intestinal malrotation in adults is a condition of difficult primary diagnosis, since it is not among the initial diagnostic hypotheses of the general surgeon.
Intestinal malrotation; Adults
