Rare Gastrointestinal Malrotation in an Adult Coexisting with an Incarcerated Incisional Hernia: A Case Report

Abstract

Background: Intestinal malrotation in adults, a previously overlooked entity, coexisting with an incisional hernia is rare. The occurrence of these two acute abdominal conditions can increase the morbidity and/or mortality even with prompt surgical intervention. The study aimed to report a rare case of adult intestinal malrotation co-existing with an incarcerated incisional hernia, emphasizing the diagnostic and surgical challenges involved.

Case Summary: We present a 22-year-old who had an incarcerated incisional hernia following omphalocele repair who presented with chronic abdominal pain and subsequent partial intestinal obstruction. Following adequate perioperative resuscitation, urgent exploratory laparotomy was done, and an incarcerated bowel within a 2 cm umbilical fascia defect, a wide mesentery and a non-rotated bowel were observed. An appendectomy and a tissue-based repair of the defect were performed under general anaesthesia with endotracheal intubation. Immediate post-operative period and subsequent recovery profile were uneventful and she was discharged postoperative day seven.

Conclusion and Recommendation: This case highlights the clinical complexity of coexisting intestinal malrotation and incisional hernia following omphalocele repair. Adults presenting with atypical abdominal symptoms, especially in the context of previous abdominal wall defects, should be suspected. Multidisciplinary evaluation and individualized surgical planning are essential for a good outcome.