A rare case of midgut reverse rotation presenting with cecal volvulus in a young adult.

INTRODUCTION AND

IMPORTANCE

Congenital malrotation is a disease that almost exclusively affects newborns. When it is discovered in an adult, which happens seldom, it is usually linked to a protracted history of gastrointestinal problems. Reversed rotation of the midgut is the rarest form of midgut malrotations. Small intestinal obstruction caused by volvulus or peritoneal bands is a common consequence of these conditions that typically manifest in the early stages of infancy.

CASE PRESENTATION: Here, we present a case of 20-year-old young adult male presented with clinical signs and symptoms of small bowel obstruction. He had gangrenous cecal volvulus with reverse rotation of the midgut. We did emergency exploration and right hemicolectomy.

CLINICAL DISCUSSION: Reversed rotation of the midgut a condition where the transverse colon lay posteriorly to the superior mesenteric artery, while the third part of the duodenum lay anteriorly. Clinical diagnosis is difficult since both intestinal malrotation and cecal volvulus are rare conditions. As a result, pre-operative diagnosis of volvulus now requires abdominal computed tomography (CT). Literature has described the "whirl" sign, beak sign, intestinal twisting, and volvulus orientation. Surgery is the most effective treatment. Also documented in literature is the option of laparoscopic cecopexy and endoscopic detortion.

CONCLUSION

Reverse rotation of the midgut, though it is a very rare clinical entity, it should be considered as a differential in adults, and it can present with cecal volvulus. High index of suspicion and routine evaluation of suspected intestinal obstruction with CT scan can avoid delay in diagnosis and improve outcomes.