Recurrent duodenal obstruction caused by Ladd's bands in an adult: a case report and review of the literature.

Introduction: Intestinal malrotation is a congenital anomaly resulting from incomplete midgut rotation. While it most commonly becomes symptomatic in infancy, adult presentations are rare and pose diagnostic difficulties. In particular, obstruction due to persistent Ladd's bands in adults is uncommon and requires surgical attention. Presentation of the case: We describe a 43-year-old male patient with recurrent episodes of small-bowel obstruction over 3 years. The initial presentation included bilious vomiting and CT evidence of duodenal obstruction, which was managed conservatively. Upon recurrence, diagnostic laparoscopy identified only adhesions; however, repeated imaging and persistent symptoms prompted a second laparoscopic intervention. Intraoperatively, intestinal malrotation with rigid Ladd's bands compressing the duodenum was identified. A laparoscopic Ladd's procedure was performed, including division of the bands and repositioning of the bowel. An appendectomy had been performed in childhood. The patient recovered uneventfully and remains symptom-free at follow-up. Discussion: Adult intestinal malrotation may present with nonspecific symptoms such as intermittent abdominal pain, nausea, or obstruction. Characteristic CT findings (e.g., inverted mesenteric vessels and abnormal bowel positioning) should raise suspicion for malrotation. Although guidelines for adults are lacking, the Ladd's procedure remains the standard of care. An elective approach may reduce complication rates compared with emergency surgery. Conclusion: In adults with recurrent duodenal obstruction and suggestive imaging findings, malrotation with Ladd's bands should be considered. Early surgical intervention via a Ladd's procedure can relieve symptoms and prevent serious complications.