Introduction: Intestinal malrotation is a rare congenital anomaly resulting from abnormal rotation of the midgut around the superior mesenteric artery, while Meckel’s diverticulum represents persistence of the vitellointestinal duct. The coexistence of these two anomalies in adults is extremely uncommon and may present as acute or recurrent intestinal obstruction. Case Presentation: We report a 19 year old female with a long history of intermittent abdominal pain, decreased appetite, and constipation. CT imaging revealed acute small bowel obstruction with mid ileal stricture and intestinal malrotation. Diagnostic laparoscopy demonstrated a tubular structure connecting the small bowel to the umbilicus, suspicious for Meckel’s diverticulum, with constrictive bands and adhesions causing obstruction. The patient underwent supraumbilical laparotomy, adhesiolysis, ileo ileal resection, and end to end anastomosis. Postoperative recovery was uneventful. Discussion: The concurrence of intestinal malrotation and Meckel’s diverticulum is rare, with few cases reported in literature. Both anomalies predispose to recurrent abdominal pain and obstruction, complicating diagnosis in adults. Early recognition and surgical intervention are essential to prevent complications such as gangrene, perforation, or short bowel syndrome. Conclusion: This case highlights the importance of considering unusual congenital associations in patients with recurrent abdominal pain or unexplained obstructive symptoms. Diagnostic laparoscopy and timely surgical management remain crucial in achieving favorable outcomes. Keywords: Intestinal malrotation, Meckel’s diverticulum