Waugh Syndrome Presenting in Late Childhood: A Case of Atypical Age and Anatomy

Waugh syndrome is the rare coexistence of intussusception and intestinal malrotation. We describe the case of a nine-year-old boy who initially presented with nonspecific gastrointestinal symptoms mimicking viral gastroenteritis. His condition worsened over several days, progressing to bowel obstruction. Imaging with contrast-enhanced CT confirmed an extensive ileocolic intussusception, although an associated malrotation was not recognized on the initial report. Given clinical deterioration, an exploratory laparotomy was performed. Intraoperative findings revealed a large ileocecal intussusception (involving the terminal ileum, appendix, cecum, and ascending colon) extending into the transverse colon, along with a midgut volvulus and underlying malrotation of the intestine. The intussusception was successfully reduced manually, an inflamed appendix within the intussuscepted segment was removed, and a Ladd's procedure was carried out to correct the malrotation. The child recovered uneventfully and remained asymptomatic on follow-up. This case highlights an atypical age presentation of intussusception due to malrotation (Waugh syndrome) and underscores the importance of maintaining a high index of suspicion in older children. Early surgical intervention was critical in confirming the dual pathology and achieving a favorable outcome.