[Intestinal perforation secondary to intestinal malrotation in an adult: Case report].

BACKGROUND

Intestinal malrotation is a congenital anomaly resulting from abnormal rotation of the intestine during fetal development, affecting its fixation and orientation. Although it is primarily diagnosed in infancy, it can cause severe complications in adults, such as intestinal obstruction, volvulus, and perforation. The objective is to illustrate the clinical presentation and management of intestinal malrotation in adults, highlighting the complications and the importance of early diagnosis.

CLINICAL CASE: 53-year-old man with generalized abdominal distension and pain, nausea, vomiting, and absence of bowel movements. Computed tomography (CT) revealed free air and fluid in the abdominal cavity, suggesting intestinal perforation. Surgery revealed cecal perforation, necrosis of the ascending colon, and a characteristic malrotation pattern. A right hemicolectomy, resection of affected intestinal segments, and creation of a terminal ileostomy were performed.

CONCLUSIONS

Intestinal malrotation in adults can present with nonspecific symptoms, complicating its diagnosis. Secondary obstruction can lead to increased intraluminal pressure, ischemia, and perforation. Perforation, resulting from prolonged obstruction, requires early diagnosis with CT. Urgent surgical intervention is essential to repair the perforation and the intestinal malrotation. The Ladd procedure is the standard treatment to correct malrotation and prevent future complications.