Intestinal Malrotation and Midgut Volvulus

Malrotation is a spectrum of anatomic abnormalities of intestinal rotation and fixation of the intestinal tract during fetal development. Clinical presentation is commonly seen in neonates and infants with intestinal obstruction and catastrophic midgut volvulus, while older children may remain asymptomatic till acute obstruction occurs or suffer chronic symptoms till the correct diagnosis is made. A diagnosis of midgut volvulus must be excluded in infants with bilious emesis using upper gastrointestinal series. Adequate fluid resuscitation must be instituted to ensure hemodynamic stability, and prompt surgical intervention is essential to prevent entire midgut gangrene. Ladd’s procedure remains the definitive treatment and comprises steps to correct the fundamental anomaly. When extensive bowel resection is required, short-bowel syndrome may ensue requiring total parenteral nutrition. Mortality for malrotation is increased in younger patients, patients with clinical abnormalities, or those with bowel necrosis.