Incidental Intestinal Malrotation During Surgery for a Perforated Duodenal Ulcer in an Older Man: A Case Report

Abstract Background: Intestinal malrotation is a congenital abnormality of intestinal rotation and fixation that may remain unrecognized until adulthood. It may be discovered during an operation for an unrelated abdominal condition.

Case presentation

A 70-year-old man presented with sudden severe epigastric pain, bilious vomiting, abdominal tenderness, guarding, and rigidity. He reported longstanding constipation, dyspeptic symptoms, and regular NSAID use. An X-ray showed free air under the right hemidiaphragm. Laparotomy on 20 February 2020 identified a 5 mm anterior perforation of the first part of the duodenum, with inflammation and bilious peritoneal contamination. An omental (Graham) patch repair was performed. Malrotation was discovered incidentally, with abnormal bowel positions, a narrow mesenteric base, and Ladd’s bands. It was not corrected because it was unrelated to the operative indication and consent had not been obtained. Helicobacter pylori testing was positive, and eradication therapy was commenced. Bowel function and oral intake resumed within 72 hours. The patient was discharged on postoperative day 5 and had no complaints at review 10 days after surgery. He was counselled and referred for specialist assessment of the malrotation.