Midgut volvulus on Ladd’s bands in a young adult with a virgin abdomen, reported as normal rotation on computed tomography and twice misdiagnosed as gastroenteritis: a case report
This case report highlights a rare instance of midgut volvulus caused by Ladd's bands in a young adult with a virgin abdomen, emphasizing the critical diagnostic challenges posed by initial misdiagnoses of gastroenteritis and conflicting CT findings that incorrectly suggested normal bowel rotation despite the presence of a mesenteric whirlpool sign.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The human body is a complex machine, but sometimes its most dangerous failures come from parts that were never built quite right in the first place. In the developing fetus, the intestines perform a precise series of twists and turns to find their final resting place inside the belly. If this process stops short or goes wrong, the intestines can end up in the wrong spot, held together by narrow, fragile connections instead of a broad, stable base. This condition, known as intestinal malrotation, often reveals itself in newborns with severe vomiting, but it can sometimes hide silently for decades. The danger lies in the fact that these misplaced intestines can easily twist around themselves, cutting off their own blood supply. This twisting, called a volvulus, is a medical emergency where every minute counts; if the blood flow is not restored quickly, the intestine can die, requiring extensive removal. For doctors, diagnosing this in an adult who has never had surgery is a particular challenge, because the usual signs of a blockage are often missing, and the condition is rarely the first thing they suspect.
This story follows a twenty-one-year-old man who arrived at a hospital with five days of severe stomach pain and vomiting. He had never undergone surgery before, and his abdomen was completely free of scars. He had been to the emergency room twice in the first three days of his illness, and both times he was told he had a stomach bug and sent home. The doctors believed his symptoms were caused by a viral infection, a common diagnosis for young adults with vomiting. However, the patient was not opening his bowels at all, a sign that contradicted the idea of a simple stomach bug, which usually causes diarrhea. By the time he returned for a third visit, he was weak and dehydrated, with his kidneys beginning to fail due to a lack of fluids. His belly felt soft and flat to the touch, which is unusual for a severe blockage, leading some to believe the problem was not serious.
The turning point came when a specialized scan, a computed tomography image, was finally taken. The scan showed a clear picture of a twisted mess in the center of his abdomen, where the blood vessels and intestines had spiraled around each other like a corkscrew. This twisting was blocking the passage of food and fluid. The scan also showed that the bowel was not dead yet, but it was under immense pressure. Despite the scan clearly showing the twist, the radiologist who read the image added a confusing note: the report stated that the patient's intestines were in their normal positions and did not show the typical signs of the birth defect that caused the twist. This created a moment of doubt, as the image showed a life-threatening emergency caused by a condition the report claimed was not present.
The medical team decided to operate immediately. When the surgeons opened the abdomen, they found exactly what the scan had hinted at, but what the report had missed. The patient's intestines were indeed twisted around the root of their blood supply. The blockage was caused by thin, fibrous bands of tissue stretching across the intestine, a remnant of the incomplete rotation that occurred before he was born. These bands, known as Ladd's bands, were pinching the intestine shut. The surgeons untwisted the bowel, cut the bands to free the intestine, and widened the base where the intestines attach to the body to prevent it from twisting again. They also removed his appendix, not because it was sick, but because the unusual position of his intestines would make it very difficult to find if he ever needed surgery for appendicitis in the future.
The patient recovered quickly. His kidney function returned to normal, and he was able to eat and move around within a few days. The case highlights a critical lesson for medical practice: a soft, flat belly does not always mean a person is safe, especially when they are vomiting and cannot pass gas or stool. It also shows that even a high-tech scan can be misleading if the acute emergency distorts the anatomy enough to hide the underlying cause. The twist was real, and the danger was immediate, even though the report said the anatomy looked normal. The surgeons had to trust the evidence of the twist itself rather than the report's conclusion about the patient's birth anatomy.
This case serves as a reminder that some medical conditions can lie dormant for a lifetime, only to strike suddenly in adulthood. The patient had lived a healthy life for twenty-one years without a single symptom, yet the structural flaw was there from the start. The delay in his diagnosis, caused by the assumption that his symptoms were just a stomach bug and the misleading scan report, nearly cost him his bowel. The successful outcome depended on the surgeons recognizing that the presence of a twist on a scan is a surgical emergency, regardless of what the rest of the report says about the patient's anatomy. It underscores the importance of looking beyond the obvious and understanding that in the human body, what is not seen on a scan can sometimes be just as important as what is.
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