title: Adult midgut malrotation presented with acute bowel obstruction and ischemia.
abstract: BACKGROUND
  Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis.
  
  
  METHODS
  40 years old female patient admitted to emergency service with acute abdomen and computerized tomography scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating "whirpool sign".
  
  
  CONCLUSIONS
  Malrotation in adults is a rare cause of midgut volvulus as though it should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Even though clinical symptoms are obscure, adult patients usually present with vomiting and recurrent abdominal pain due to chronic partial obstruction. Contrast enhanced radiograph has been shown to be the most accurate method. Typical radiological signs are corkscrew sign, which is caused by the dilatation of various duodenal segments at different levels and the relocation of duodenojejunal junction due to jejunum folding. As malrotation commonly causes intestinal obstruction, patients deserve an elective laparotomy.
  
  
  CONCLUSIONS
  Malrotation should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Surgical intervention should be prompt to limit morbidity and mortality.
authors.affiliation: Department of General Surgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey. Electronic address: dr.akile.zengin@gmail.com.
authors.forename: Akile
authors.initials: A
authors.lastname: Zengin
authors.affiliation: Department of General Surgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey.
authors.forename: Bercis İmge
authors.initials: Bİ
authors.lastname: Uçar
authors.affiliation: Department of General Surgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey.
authors.forename: Şükrü Aydın
authors.initials: ŞA
authors.lastname: Düzgün
authors.affiliation: Department of General Surgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey.
authors.forename: Zülfü
authors.initials: Z
authors.lastname: Bayhan
authors.affiliation: Department of General Surgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey.
authors.forename: Sezgin
authors.initials: S
authors.lastname: Zeren
authors.affiliation: Department of General Surgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey.
authors.forename: Faik
authors.initials: F
authors.lastname: Yaylak
authors.affiliation: Department of Radiology, Dumlupınar University Faculty of Medicine, Kütahya, Turkey.
authors.forename: Bekir
authors.initials: B
authors.lastname: Şanal
authors.affiliation: Clinic of Anesthesiology, Ministry Health Dumlupınar University Evliya Çelebi Training and Research Hospital, Kütahya, Turkey.
authors.forename: Nilüfer Araz
authors.initials: NA
authors.lastname: Bayhan
keywords: Intestinal obstruction; Ladd’s procedure; Malrotation; Whirlpool sign