title: A rare presentation of midgut malrotation as an acute intestinal obstruction in an adult: Two case reports and literature review.
abstract: BACKGROUND
  Midgut malrotation is a congenital anomaly presenting mainly in the childhood. Its presentation as an acute intestinal obstruction is extremely rare in adults usually recognized intra-operatively, therefore a high index of suspicion is always required when dealing with any case of acute intestinal obstruction.
  
  
  METHODS
  We report two cases of young adults who presented with symptoms of acute intestinal obstruction and were diagnosed intra-operatively as cecal volvulus and paraduodenal hernia, respectively, caused by midgut malrotation. Post-operative CT scan confirmed these findings.
  
  
  CONCLUSIONS
  Malrotation of the intestinal tract is a product of an aberrant embryology. The presentation of intestinal malrotation in adults is rare (0.2-0.5%). Contrast enhanced CT can show the abnormal anatomic location of a right sided small bowel, a left-sided colon and an abnormal relationship of the superior mesenteric vein (SMV) situated to the left of the superior mesenteric artery (SMA) instead of to the right.
  
  
  CONCLUSIONS
  Anomalies like midgut malrotation can present as an operative surprise and awareness regarding these anomalies can help surgeons deal with these conditions.
authors.affiliation: Department of General Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, India. Electronic address: shailsurg@gmail.com.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Singh
authors.forename: Anupam
authors.initials: A
authors.lastname: Das
authors.forename: A S
authors.initials: AS
authors.lastname: Chawla
authors.forename: S V
authors.initials: SV
authors.lastname: Arya
authors.forename: Jasneet
authors.initials: J
authors.lastname: Chaggar