Midgut malrotation as a rare cause of chronic abdominal pain: a case report and review of literature

Abnormalities in midgut rotation occur during the physiological herniation of the midgut between the 5th and 10th week of gestation. The most significant abnormality is a narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period. Less commonly, midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 31-year-old female patient who presented with a 6-year history of non-specific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following an upper gastro-intestinal series. The patient was treated with a laparoscopic Ladd's procedure and at 3 months was gaining weight and had stopped vomiting. A laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults.