Midgut volvulus with internal herniation through a mesenteric defect: A case report

ABSTRACT Introduction Intestinal malrotation rarely presents beyond infancy, and its coexistence with high-degree midgut volvulus and internal herniation through a mesenteric defect in an older child is exceedingly rare. Case Presentation A previously healthy 10-year-old boy presented with a 10-hour history of acute abdominal pain, bilious vomiting, distension, and failure to pass stool or flatus. Examination showed tachycardia, dehydration, and marked distension. Plain abdominal radiography demonstrated dilated bowel loops with air-fluid levels. Emergency laparotomy revealed a 540° anticlockwise midgut volvulus with herniation of distal ileum through a mesenteric defect, alongside a right-sided cecum and duodenojejunal junction confirming malrotation. Detorsion, reduction, Ladd’s procedure, mesenteric defect closure, and incidental appendectomy preserved bowel viability without resection. The patient was discharged on postoperative day 7 and remained entirely asymptomatic at six-month follow-up. Conclusion Intestinal malrotation can present with high-degree midgut volvulus and internal herniation even in older children, and prompt surgical exploration guided by clinical findings and plain radiography can achieve complete bowel salvage even where advanced imaging is unavailable.