Midgut malrotation and ovarian dermoid cyst as a dual cause of neonatal intestinal obstruction: a case report and literature review.

Introduction and importance: Midgut malrotation is a congenital anomaly characterized by impaired rotation of the gut around the superior mesenteric artery during embryonic development. It is one of the most common causes of neonatal intestinal obstruction. A dermoid cyst arises from the trapping of ectodermal elements during embryonic development. Case presentation: A 6-day-old female neonate was brought to the hospital with a history of bilious emesis and failure to pass stool. The antenatal history was uneventful. She was diagnosed with intestinal obstruction. The patient was treated initially as a case of clinical sepsis and then treated surgically. Through a transverse incision, the abdomen was explored, and midgut malrotation with Ladd's bands was found under an adhering ovarian cyst, which was diagnosed as a dermoid cyst by histopathology. The simultaneous dual-cause obstruction in this case has prompted us to report it. Clinical discussion: Malrotation results when the midgut fails to complete its 270° counterclockwise rotation in utero, leading to anomalous positioning and often to fibrous Ladd's bands that cross and compress the duodenum. Meanwhile, congenital ovarian dermoid cysts can contribute to obstruction through adhesive bands or direct mass effect. The concurrent occurrence highlights the importance of considering multiple simultaneous etiologies in diagnosis and surgical planning. Conclusion: Considering multiple congenital defects, such as malrotation and dermoid ovarian cysts, as a dual cause of intestinal obstruction is important in a condition that has a large differential diagnosis.