Anatomical Correction of Adult Intestinal Malrotation Using Kareem’s Procedure: A Case Report

Waheeb Radman Al-Kubati,1– 3 Mansour Mohammed Al-Hameli,4 Nardeen Alqousi,3 Anas Al-Kubati,1 Abdullah Al-Kubati,1 Bilal Sleiay51Surgical Department, 21 September University, Sana’a, Yemen; 2Physiology Department, Sana’a University, Sana’a, Yemen; 3Surgery Department, Althowra Modern General Hospital, Sana’a, Yemen; 4Department of Radiology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen; 5Surgery Department, Faculty of Medicine, Hama University, Hama, SyriaCorrespondence: Waheeb Radman Al-Kubati, Surgical Department, 21 September University, Sana’a, Yemen, Email waheebradman@yahoo.comBackground: Intestinal malrotation (IM) is a congenital defect in midgut rotation or fixation that results in abnormal positioning of the bowel. Although most cases present during infancy, adult presentation is uncommon and may be misdiagnosed. Kareem’s procedure is an anatomical corrective approach described for gut malrotation; however, evidence regarding its use remains limited.Case Presentation: A 26-year-old female presented with sudden, severe, colicky central abdominal pain associated with non-bilious vomiting and complete constipation for 10 hours. She had experienced a similar self-limited episode one month earlier. Contrast-enhanced abdominal CT revealed inversion of the SMA/SMV relationship, right-sided clustering of small bowel loops, and abnormal position of the duodenojejunal junction, consistent with intestinal malrotation with acute complications. The patient underwent anatomical correction using Kareem’s procedure. At follow-up, she reported relief of abdominal pain, and CT confirmed normalization of the SMA/SMV relationship, cecal position in the right iliac fossa, and jejunal loops in the left abdomen.Conclusion: IM should be considered in adults with unexplained abdominal pain or features of intestinal obstruction. Kareem’s procedure was feasible in this patient and was associated with a favourable outcome. Further evidence is needed before drawing conclusions about comparative effectiveness.Keywords: intestinal malrotation, Kareem’s procedure, adult intestinal malrotation