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

Hussein Hmadeh, Christian Saliba, Mohamad Raka, Hammam Ahmad Farhat, Ali Dabbous, Samer Diab, Layan Abbas, Ali Wehbe

(Department of General Surgery, Sahel General Hospital, Beirut, Lebanon)

Am J Case Rep 2018; 19:1362-1365

DOI: 10.12659/AJCR.913039

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.

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