Introduction : Malrotation of gut is a congenital anomaly of foetal intestinal rotation and it is mostly discovered in early childhood as acute intestinal obstruction. This condition is very rare and often silent in adults.

Presentation : A 28 year old male patient was brought to ER with chief complaints of abdominal distension and 1 episode of vomiting and constipation. Patient is mentally retarded and past history revealed seizures.

Facial Angiofibromas

Pulse rate is 123/minute, BP 90/60mmhg, and per abdomen finding is distended abdomen (tense) guarding noted. X ray erect abdomen showed multiple air fluid levels. Abdominal CT showed acute small bowel obstruction due to band at caecum and malrotation of bowel loops noted. Also a finding of renal angiomyolipomas is made.

MRI brain done showing features o f tuberous sclerosis.

On laparotomy multiple dilated small bowel loops with band noted between caecum and retroperitoneum (Ladd’s). Ladd’s band releasing done then mobilization of caecum till right hepatic flexure done. Appendectomy done.

Untwisting of small bowls done. Releasing of ligament of Treitz and plains. The small bowels loop is in right iliac fossa done drain kept.Patient recovered well.

Conclusion : Intestinal obstruction is a rare entity and adult presentation in even rarer.Some cases are asymptomatic but when symptomatic a volvulus should be promptly suspected to avoid complications such as bowel ischemia.