Intestinal malrotation is diagnosed in the first month. After birth for the great majority of patients. The incidence of malrotation in adulthood is 0.2%. A 14-year girl presented to our emergency department with c/o bilious vomiting for last 5days, pain abdomen in periumbillical region for last 3 days and not passing stool for last 3 days. No h/o fever or burning micturation. midgut malrotation was diagnosed in ultrasonography and CT scan. Then exploratory laparotomy followed by the division

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... d by the division of ladd band done. Derotation of malrotated midgut done. Appendicectomy done. placement of illeocaecal junction to left iliac fossa and jejunum on right paracolic gutter done. Peritoneal toileting done and abdomen was closed in layers. Post operatively patient recovered well. Malrotation of gut in adult with features of acute intestinal obstruction is rare Complete resolution of acute obstruction or chronic abdominal pain is the result of a high index of suspicion for malrotation, appropriate diagnostic studies and aggressive definitive treatment.