Malrotation can be difficult to diagnose beyond the newborn period because of its non-specific symptoms and clinical findings. We present an unusual case of malrotation with midgut volvulus and superior mesenteric vein thrombosis in an adolescent. An 11-year-old girl presented to the paediatric emergency department with persistent vomiting, dyselectrolytemia, and metabolic alkalosis. An unremarkable abdominal radiograph and ultrasonography examination prompted a computerised scan of the abdomen. The diagnosis of malrotation with midgut volvulus and superior mesenteric vein thrombosis was made. The findings were confirmed on laproscopy and the patient underwent successful Ladd’s procedure. This case report emphasizes the importance of imaging, especially computed tomography, in making accurate diagnosis of malrotation and its complications, beyond the newborn period.