# Surprising intraoperative discovery of a Ladd’s band in a patient with midgut volvulus associated with intestinal malrotation: a case report

## TL;DR

A 33-year-old woman with acute abdominal pain had a rare case of intestinal malrotation and a Ladd’s band discovered during surgery.

## Contribution

This case report highlights the limitations of CT in diagnosing the exact cause of obstruction in adult intestinal malrotation.

## Key findings

- CT imaging suggested midgut volvulus and malrotation but failed to identify the obstructive mechanism.
- Surgical exploration revealed a congenital Ladd’s band causing extrinsic duodenal obstruction.
- The case emphasizes the need for surgical confirmation in complex adult intestinal malrotation cases.

## Abstract

Adult intestinal malrotation is a rare condition and may remain undiagnosed until the occurrence of acute complications. We report the case of a 33-year-old woman presenting with acute abdominal pain. Contrast-enhanced computed tomography (CT) demonstrated an abnormal relationship between the superior mesenteric artery and vein, right-sided small bowel loops, left-sided colonic segments and a mesenteric whirlpool sign, consistent with midgut volvulus associated with intestinal malrotation. Although CT allows reliable identification of intestinal malrotation and midgut volvulus, the precise obstructive mechanism may remain undetermined preoperatively. Surgical exploration revealed a congenital Ladd’s band crossing the duodenum and causing extrinsic duodenal obstruction. In addition, an associated midgut volvulus related to intestinal malrotation was confirmed intraoperatively. This case highlights the diagnostic value and limitations of CT in adult malrotation and emphasizes the importance of surgical exploration to identify the true obstructive mechanism.