Midgut malrotation (MMR) is the abnormal rotation of the foetal midgut around the axis of the superior mesenteric artery which in symptomatic neonates requires a Ladd's procedure. We present a rare case of midgut volvulus occurring in a teenager 3 days after observational management of incidentally discovered MMR during laparoscopic appendectomy. A Ladd's procedure was performed and the patient is well at one-year follow up. We suggest prophylactic Ladd's procedure remains the treatment of choice for MMR even when discovered incidentally.
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