S ymptomatic bowel malrotationfirst presenting in the adult is rare.Midgut volvulus is the most com mon complication of malrotation in the adult. CT can play an important role in the evaluation of patients with this abnormality. The whirl pattern around the superior mesenteric artery found on CT in patients with midgut volvulus is diagnostic if clearly seen [11. We present a case of bowel malrotation complicated by midgut volvulus in an adult patient. The preop erative CT findings were pathognomonic. Case ReportA 33-year-old man presented with acute epigastric pain and bilious vomiting. He had beenpreviously diagnosedwith irritable bowel syndromeand a left ureteropelvicjunction ob struction. On physical examination, he had a palpable, tender mid epigastric mass. Abdomi nal radiographsdid not revealdilated bowel or other abnormalities.A CT scan showed the typical findings of midgut volvulus (Figs. 1Aâ€"1D). The small bowel was twisted around the superior mesen teric artery. The superior mesentericvein was to the left of the superior mesentenc artery. Venous engorgement and mesenteric edema were present.The cecum was positioned in the right upperquadrantof the abdomen.At surgery,the small bowel was found to be twisted several times around the superior mes enteric artery. No bowel necrosiswas present. Thepatientunderwent surgical correction usingLadd's procedureand an appendectomy. He re mainsasymptomatic15monthsafter surgery.

Absence of the appendix is rare. Isolated cases are usually discovered in adult patients or cadavers. We report the case of a 14 year old boy who was found to have no appendix on laparotomy for assumed acute appendicitis and use this opportunity to highlight the growing surgical uses of this vestigial structure.