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<b>Introduction</b> Adult midgut malrotation is very rare. The presentation in adults is mostly subtle; the diagnosis is often made on imaging.
<b>Case report</b> A 32-year-old man presented with a 3-day history of an irreducible painful mass protruding per rectum, followed by abdominal pain and constipation. The patient was febrile and toxic, with marked signs of peritonitis and complete fullthickness irreducible rectal prolapse. Abdominal radiographs showed multiple air-fluid levels. A diagnosis of irreducible re