• Abdominal CT
• Adult intestinal obstruction
• Ladd's procedure
• Malrotation
• Mid-gut volvulus

• After infancy
• Presentation of malrotation beyond infancy is infact more than that reported in literature. Timely and appropriate diagnosis of malrotation is essential to avoid gangrene and subsequent gut loss and morbidity.
• delayed
• malrotation of gut
• presentation

• Children
• Malrotation
• Volvulus
• Vomiting

• Humans
• Male
• Retrospective Studies
• Female
• Intestinal Volvulus/surgery
• Intestinal Volvulus/diagnosis
• Child, Preschool
• Infant
• Child
• Adolescent
• Infant, Newborn
• Digestive System Abnormalities/surgery
• Digestive System Abnormalities/complications
• Digestive System Abnormalities/diagnosis
• Treatment Outcome
• Postoperative Complications/epidemiology

• Ankara Yıldırım Beyazıt University

• GI motility
• disorders of the gut and brain interaction (DGBI)
• functional gastrointestinal disorders
• neurogastroenterology and motility
• pediatrics

• Child
• Humans
• Male
• Female
• Infant
• Infant, Newborn
• Child, Preschool
• Adolescent
• Young Adult
• Adult
• Retrospective Studies
• Quality of Life
• Gastrointestinal Diseases/epidemiology
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/surgery
• Brain Diseases
• Brain
• Digestive System Abnormalities
• Intestinal Volvulus

• No funding has been obtained for this scholarly work.

• Abdominal computed tomography
• Case report
• Congenital malformation
• Gastric cancer
• Intestinal malrotation
• Laparoscopic surgery

• Humans
• Intestinal Volvulus/etiology
• Intestinal Volvulus/surgery
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/surgery
• Digestive System Abnormalities/surgery

•

Midgut malrotation is a congenital condition caused by insufficient normal intestinal rotation following physiologic gut herniation.

To classify adult intestinal malrotation by CT.

This retrospective study enrolled adults diagnosed with intestinal malrotation who underwent abdominal CT at our institution between June 1, 2013, and August 30, 2020. All patients’ clinical information was recorded. Patients were divided into groups undergoing surgical and conservative management. The duodenum (nonrotation, partial rotation, and malrotation), jejunum, cecum, and the superior mesenteric artery/superior mesenteric vein relationship were reviewed on the CT images of each patient, and classification criteria developed based on the first three items. For each patient, each item was assessed separately by three radiologists. Consensus was required from at least two of them.

A total of 332 eligible patients (218 men and 114 women; mean age 51.0 ± 15.3 years) were ultimately included and classified into ten types of malrotation. Duodenal partial rotation was present in most (73.2%, 243/332) with only 25% (83/332) demonstrating nonrotation. The jejunum was located in the right abdomen in 98.2% (326/332) of cases, and an ectopic cecum was found in only 12% (40/332, 29 cases with a left cecum, 7 pelvic, and 4 at midline). Asymptomatic patients comprised 56.6% (188/332) of cases, much higher than that in previous studies (17%, n = 82, p < .001), comprised mainly of patients with duodenal partial rotation (80.3%, 151/188). In 91 patients with detailed clinical data available (12 managed surgically and 79 conservatively), a significant difference in malrotation CT categorization was identified (p = .016).

CT enables greater detection of asymptomatic intestinal malrotation, enabling classification into multiple potentially clinically relevant subtypes.

The online version contains supplementary material available at 10.1186/s13244-021-00999-3.

• Adults
• Computed tomography
• Diagnosis
• Intestinal malrotation

•

Intestinal malrotation and midgut volvulus in adulthood are rare events.

Intestinal malrotation is a rare condition, with an incidence estimated between 0,2 to 1%. Most cases are diagnosed and treated during childhood. Adult presentations are rare and most adults present with chronic nonspecific complaints.

Midgut volvulus is the most feared complication of intestinal malrotation, far more common among the pediatric than the adult population. Presentation in adulthood with a midgut volvulus accounts for a minority of these patients (15%).

The Ladd procedure is the standard surgical management of midgut volvulus and intestinal malrotation. Most evidence on the outcomes of the Ladd procedure originates from studies on pediatric population and the recurrence among children who have had a Ladd procedure is low (2–7%).

We report an exceedingly rare case of a patient who presented in adulthood with a midgut volvulus and less than two years after undergoing Ladd procedure presented with a recurrence of the midgut volvulus. The recurrent midgut volvulus was successfully treated by a fixation procedure (cecopexy and duodenopexy).

Reports of midgut volvulus in adult patients are scarce and reports of recurrence even scarcer hence the rate of recurrence among adult patients has yet to be determined. The recurrence rate in some of the available adult series is much higher than the rate reported among children.

Should the rate of recurrence among adult patients prove higher, it poses the question of whether the Ladd procedure should be modified to include bowel fixation when performed in adults.

• Case report
• Intestinal malrotation
• Ladd procedure
• Midgut volvulus
• Recurrent