Background: Intestinal malrotation, a congenital anomaly, typically presents in neonates with midgut volvulus. However, recent studies suggest it may occur in adolescents and adults at a higher rate than previously thought. This case report investigates the presentation and management of malrotation with volvulus in an adolescent. Case Presentation: A 14-year-old boy presented with acute onset abdominal pain, vomiting, and a history of intermittent abdominal pain for several years. Initial diagnosis was gastritis, but imaging revealed malrotation with volvulus. He underwent a successful Ladd's procedure. Conclusion: This case emphasizes that malrotation can present with chronic or acute symptoms in adolescents. A high index of suspicion for malrotation is crucial, particularly in adolescents with recurrent abdominal pain. Early diagnosis and Ladd's procedure can prevent life-threatening complications.