Malrotation of the gut harbouring midgut volvulus in an adult with situs inversus totalis: a clinical delay and treatment dilemma.

A 22-year-old man experiencing infrequent episodes of abdominal pain, distension, non-bilious vomiting and constipation, was diagnosed with malrotation of the gut. He was treated conservatively over the past 10 years. He was referred to our hospital owing to recent aggravation of symptoms. He had no signs of peritonitis. On imaging, malrotation of the gut, with midgut volvolus and situs inversus totalis, was found. Diagnosis was confirmed during laparotomy. A large sac was present to the right of midline. Detorsion of the sac was performed and the sac was opened. The duodenum and caecum were found in the left upper abdomen adherent to the lateral abdominal wall. Adhesiolysis was performed and extrinsic compression at the duodenum relieved. The large bowel was placed on the right side and small bowel was placed on the left. Appendectomy and feeding jejunostomy were performed. Thorough analysis (clinicoradiological) is necessary before considering conservative management in patients known to harbour a congenital anomaly of the gut.