An Interesting Case of Intestinal Obstruction Due To Nonrotation of Midgut and Internal Hernia

A case of malrotation of midgut loop with right para duodenal hernia in an adult male who presented with recurrent abdominal pain, vomiting and features suggestive of intestinal obstruction. Intestinal rotation is a well-known cause of obstruction in neonates and children and may present as midgut volvulus. Thiscondition is uncommon in adults and may present as vague intermittent abdominal pain or sometimes acutely as upper GI obstruction. CT abdomen showed abnormally positioned duodenojejunal flexure on the right side of abdomen suggesting mal-rotation. Clustered and dilated small bowel loops with narrow mesenteric pedicle and features of closed loop obstruction were seen in the right para duodenal region suggesting internal hernia. The diagnosis of malrotation with or without associated complications like internal hernia or volvulus should always be kept in mind when evaluating adult patients with symptoms of vomiting and pain.