Malroatation of gut with superior mesenteric artery syndrome and multiple jejunal diverticula presenting as acute intestinal obstruction in 6th decade: A rare case report

• 55 year old male patient presented with features of acute intestinal obstruction.
• On exploratory laparotomy, malrotation of gut with compression of duodenum and terminal ileum by the superior mesenteric artery pedicle was found along with multiple jejunal diverticula.
• No ladd's bands or midgut volvulus was noted.
• Malrotation may present in adult age group as acute or chronic obstruction and surgeons must keep a flexible approach toward management.

INTRODUCTIONIntestinal malrotation is a disease of neonates and young children presenting as acute intestinal obstruction. Presentation of malrotation in elderly patients with intestinal obstruction is quite rare with only a few cases reported in literature. We report a case of intestinal malrotation presenting as acute obstruction in sixth decade.PRESENTATION OF CASEA 55 years old male presented to the emergency with features of acute intestinal obstruction. Imaging studies revealed intestinal malrotation. Exploratory laparotomy revealed malrotation with compression of 3rd part of duodenum and terminal ileum by superior mesenteric artery with multiple jejunal diverticula. Bypass procedures (duodenojejunostomy and ileo-colic anastomosis) with appendicectomy were done.DISCUSSIONMalrotation of gut is an anomaly usually presenting in neonatal period with complications such as midgut volvulus. Presentation in adult age is rare with most cases being asymptomatic. Ladd's procedure is the operation of choice with division of the Ladd's bands and appendicectomy being performed.CONCLUSIONSurgeons should keep a flexible approach in management of malrotation of gut presenting in late stages of life as more and more clinical variants to the presentations described in literature are being encountered.