# Malrotation in an Adult Patient With Pneumoperitoneum Following Nissen-Sleeve Gastrectomy: A Case Report

## TL;DR

A 48-year-old woman with a history of Nissen-sleeve gastrectomy was found to have intestinal malrotation during surgery for a stomach perforation, highlighting the challenges of diagnosing this condition in adults.

## Contribution

This case report highlights the rare occurrence of intestinal malrotation in adults and its diagnostic and surgical challenges.

## Key findings

- Intestinal malrotation was incidentally discovered during laparoscopy for a sealed stomach perforation.
- The anatomical variation complicated the conversion from Nissen-sleeve gastrectomy to gastric bypass.
- Adult intestinal malrotation is often overlooked and poses significant diagnostic and management challenges.

## Abstract

Intestinal malrotation is typically encountered in the first year of life and is rarely seen in adult populations. Herein, we present the case of a 48-year-old woman with a surgical history of laparoscopic Nissen-sleeve gastrectomy before 11 months who was referred to the general surgery service after presenting to the emergency department with acute epigastric abdominal pain for one-day duration. Radiography and a computed tomography (CT) scan of the abdomen revealed a large pneumoperitoneum. Subsequently, a diagnostic laparoscopy was performed, which detected a sealed perforation in the fundus of the wrapped-sleeved stomach, along with an incidental finding of intestinal malrotation. The encountered variation of anatomy created an intraoperative challenge during the conversion from Nissen-Sleeve gastrectomy to single anastomosis gastric bypass. The diagnosis of intestinal malrotation in adults is often overlooked, posing substantial diagnostic and management challenges when encountered.