A Rare Triad of Caecal Perforation, Adult Intestinal Malrotation, and Intestinal Tuberculosis: A Case Report

Abstract

Intestinal malrotation is a congenital anomaly of embryonic midgut development that usually presents in infancy; its presentation in adults is rare. Intestinal malrotation presenting as cecal perforation is extremely uncommon, with only a single case reported. We report the case of a 70-year-old male patient who presented with acute abdomen and peritonitis. Emergency laparotomy revealed 3 × 3-cm cecal perforation at the apex associated with intestinal malrotation. Resection of the distal ileum with the ascending colon and end ileostomy were performed. Intestinal tuberculosis (TB) was postoperatively diagnosed based on histopathology. The patient recovered uneventfully on antitubercular therapy, with ileo-transverse anastomosis. Given this exceedingly rare case, clinicians should be aware of this coexistence in TB-endemic regions and should provide prompt surgical intervention. To the best of our knowledge, only one case of intestinal malrotation presenting specifically as cecal perforation has been reported. No case combining intestinal malrotation, cecal perforation, and intestinal tuberculosis has been documented, making the presented case the first reported instance of this triad.