Clinical Perspective on Midgut Nonrotation in Adults: A Clinical Case Report and Review of the Literature.

Objective: To present a case of intestinal nonrotation in a 26-year-old Indian male and conduct a detailed review of 16 additional cases from the PubMed database.

Case presentation: A 26-year-old male presented with acute right lower quadrant abdominal pain and vomiting. He had a similar episode seven years prior that self-resolved. Physical examination revealed generalized abdominal tenderness, guarding, and mild distention. Imaging studies, including abdominal ultrasound and CECT, confirmed midgut volvulus due to nonrotation. The patient underwent exploratory laparotomy and Ladd's procedure, leading to an uneventful recovery and discharge on postoperative day seven.

Material and methods: A comprehensive PubMed search was conducted for case reports on midgut nonrotation in adults. 15 relevant cases were selected, and including the present case, 16 cases were reviewed.

Results: The mean age at presentation was 55.19 years (range: 26-86), with a slight male predominance (56.2%). The most common symptoms were acute abdominal pain (50%) and vomiting (31.25%). Notably, 50% of cases were identified incidentally during evaluations for unrelated conditions or procedures. CT scans confirmed diagnoses in 87.5% of cases. Positional anomalies included right-sided small bowel and left-sided colon in 37.5% and reversed SMA/SMV relationships in 33%. Ladd's procedure was performed in 25% of cases.

Conclusion: Midgut nonrotation, resulting from abnormal embryonic bowel rotation, can occur at any age, more commonly in males. It may present as a surgical emergency due to bowel obstruction and volvulus or remain asymptomatic throughout life. CT imaging and surgical intervention, particularly Ladd's procedure, are effective management strategies. The frequent incidental discovery of cases suggests that asymptomatic nonrotation may be more prevalent than clinically recognized.