# Congenital Intestinal Malrotation With Coexistent Jejunal Diverticula in a Septuagenarian Male: A Case Report

## TL;DR

A rare case of congenital intestinal malrotation combined with jejunal diverticula causing volvulus is reported in an elderly man.

## Contribution

This case report highlights the rare coexistence of congenital intestinal malrotation and jejunal diverticula in an elderly patient.

## Key findings

- A 78-year-old male presented with acute abdomen due to intestinal obstruction caused by malrotation and jejunal diverticula.
- Ladd’s procedure was successfully performed without complications to treat the malrotation and volvulus.
- The case emphasizes the importance of considering malrotation in elderly patients with acute intestinal obstruction.

## Abstract

Intestinal malrotation is a congenital anomaly with mostly reported cases in neonates, although, in adults, limited cases have been reported in the literature. However, in adults, prompt recognition is of utmost importance to prevent drastic complications like bowel ischemia and death. We present a rare case of coexistence of congenital intestinal malrotation and jejunal diverticula presenting as a volvulus. We present a case of a 78-year-old male with no comorbidities presenting to the emergency department with an acute abdomen, diagnosed as a case of intestinal obstruction in a virgin abdomen, and treated conservatively. Meanwhile, CT abdomen and pelvis showed volvulus of the small intestine, so the patient was taken for exploratory laparotomy, which revealed the small bowel rotation with a high cecum and a narrow mesentery. Ladd’s procedure was performed without any perioperative complications. Few reports of congenital intestinal malrotation in the elderly are presented in the literature. This highlights the importance of evaluating all patients for malrotation if presenting in elderly patients with a virgin acute abdomen to prevent complications like bowel ischemia. Elderly patients presenting with acute intestinal obstruction, if not improving conservatively, should make the clinician think about congenital intestinal malrotation as a differential diagnosis as well, among all other common causes.