An adult with midgut volvulus causing diagnostic challenge: Case report

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INTRODUCTION AND IMPORTANCE: Midgut volvulus is an extremely rare cause of abdominal pain in adults, often due to intestinal malrotation. Its nonspecific and insidious presentation can lead to significant diagnostic delays, increasing the risk of intestinal ischemia, necrosis, or gangrene. Early recognition and prompt surgical intervention are crucial to improving outcomes. CASE PRESENTATION: We report a case of a 23-year-old Ethiopian male with a history of recurrent abdominal discomfort and intermittent vomiting since childhood. Despite multiple clinical evaluations and normal laboratory investigations, the diagnosis remained elusive until an abdominal computed tomography (CT) scan revealed midgut volvulus. The patient underwent an emergency Ladd's procedure and appendectomy. His postoperative recovery was uneventful, and symptoms resolved completely on follow-up. CLINICAL DISCUSSION: Midgut volvulus is primarily a pediatric diagnosis, with adult cases being extremely rare. When it does occur in adults, it typically presents with vague gastrointestinal symptoms, contributing to diagnostic delays. CT imaging remains the gold standard for diagnosis. The mainstay of treatment is surgical correction via Ladd's procedure. Awareness of this rare but serious condition is essential to reduce morbidity and mortality. CONCLUSION: Clinicians should consider midgut volvulus in adults presenting with chronic or unexplained gastrointestinal symptoms, particularly in the absence of prior abdominal surgery. Timely diagnosis and surgical management are key to preventing life-threatening complications.

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