Midgut Volvulus Secondary to Intestinal Malrotation and Meckel’s Diverticulitis: A Case Report

Abstract

Background: Volvulus, a condition where the intestines twist upon themselves, is a serious surgical emergency that commonly affects children. Midgut volvulus is frequently caused by congenital malrotation, a developmental anomaly where the intestines fail to rotate and fixate properly during fetal development. Although Meckel's diverticulum, the most prevalent gastrointestinal congenital anomaly, occurs in approximately 2% of the population, its coexistence with intestinal malrotation is rare. Case Presentation: A 7-year-old boy presented with recurrent abdominal pain and bilious vomiting over the past month, worsening in recent weeks. Physical examination revealed mild abdominal distension and tenderness, with stable vitals. Laboratory findings indicated mild leukocytosis and elevated C-reactive protein, suggesting inflammation. Imaging studies, including X-ray, ultrasound, and contrast-enhanced CT, revealed features of small bowel obstruction, midgut volvulus, and intestinal malrotation. An emergency exploratory laparotomy confirmed a volvulus caused by a fibrous band of the vitelline duct, with Meckel's diverticulum and an inflamed appendix. The patient underwent wedge excision of the Meckel’s diverticulum and appendectomy, with an uneventful recovery. He was discharged on postoperative day 4 and remained symptom-free at a 6-month follow-up. Discussion and Conclusion: Midgut volvulus, primarily caused by intestinal malrotation, is a life-threatening condition in children that can lead to bowel obstruction and ischemia. While malrotation accounts for 70-80% of volvulus cases, rarer causes, such as Meckel's diverticulum, contribute to fewer than 5%. In this case, the volvulus was further complicated by a fibrous band associated with Meckel’s diverticulitis and concurrent appendicitis. Surgical intervention, including Ladd’s procedure, wedge excision of the Meckel’s diverticulum, and appendectomy, was crucial in preventing further complications. Early diagnosis and prompt surgical correction are essential to avoid volvulus-related morbidity. This case highlights the importance of recognizing coexisting conditions like Meckel’s diverticulitis and appendicitis, which can exacerbate volvulus. The patient recovered uneventfully and remained symptom-free at follow-up, emphasizing the necessity of timely surgical intervention for successful outcomes.