Abstract Midgut volvulus associated with intestinal malrotation is a rare condition in adults, with an incidence reported between 0.2% and 0.5%, and only 15% of these cases present as midgut volvulus (Butterworth et al., 2018). Typically observed in neonates with associated birth defects within the first month of life, diagnosing this condition in adults is challenging due to non-specific symptoms. We report a case involving a 68-year-old female who experienced severe lower abdominal pain and vomiting for several hours. On examination, she exhibited abdominal distention, tenderness, and guarding. Blood tests were largely normal. An abdominal X-ray revealed a dilated right colon, while a CT scan showed significant dilation of the caecum in the right hypochondrium, with a thinned wall. Notably, the DJ flexure did not cross the midline, and multiple non-dilated small bowel loops were found on the right side, accompanied by volvulus of the superior mesenteric vessels, mesenteric congestion, and non-opacification of tributaries of the superior mesenteric vein. An emergency laparotomy revealed a caecal volvulus with the small bowel twisted anticlockwise by 360 degrees around the base of the redundant caecum and ascending colon. A right hemicolectomy was performed, and the postoperative course was uneventful. Due to the scarcity of adult cases, the timing and approach to surgical management are not well defined without specific guidelines. Recognising intestinal malrotation in adults is crucial to avoid severe complications, highlighting the need for a high index of suspicion in patients with relevant clinical signs