76 Malrotation Beyond Infancy Presenting with Volvulus and Total Ileal Resection: A Case Report

Abstract Aim Midgut malrotation is a congenital anomaly resulting from abnormal rotation and fixation of the midgut during embryogenesis. It can lead to life-threatening complications such as volvulus, intestinal obstruction, and ischemia. Prompt diagnosis and surgical intervention are crucial to prevent bowel necrosis and decrease morbidity and mortality. Malrotation is usually asymptomatic and presents with volvulus mostly during the first year of life. This case report presents a rare case of malrotation with volvulus in a 5-year-old child, highlighting the challenges in its diagnosis and management. Case Presentation A 5-year-old Arab female presented with repetitive frothy vomiting, diffuse abdominal pain, and hemodynamic instability. Laboratory findings showed leukocytosis, metabolic acidosis, and deteriorating renal and liver functions. After excluding medical causes of acute abdomen, an ultrasound was done to investigate surgical causes. Radiology suggested intestinal obstruction. Surgical exploration revealed distal jejunal malrotation with volvulus and borderline ischemia of the ileum. First operation included detorsion of the volvulus, excision of gangrenous segments, and appendectomy. Postoperatively, the patient developed acute abdominal distension with tenderness and suspected perforation, necessitating a second-look surgery with resection of the entire ileum and stoma formation. Later on, stoma closure and anastomosis were successfully performed after stabilization. The patient recovered well and was discharged on a normal diet after being under inpatient observation for 83 days. Conclusions This case underscores the complexity of diagnosing malrotation with volvulus in children older than 1 year, and the urgency of early surgical intervention to prevent severe complications. A multidisciplinary approach is crucial for optimizing outcomes in such cases.