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  • • Varying degrees of failure or absence of rotation with the small intestine being on the right and colon on the left with narrow superior mesenteric artery pedicle and Ladd bands lying across duodenum

    • 50-75% present in first month of life

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Epidemiology

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  • • 5% incidence of some variant in population

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Symptoms and Signs

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  • • Bilious emesis

    • Abdominal distention

    • Feeding intolerance

    • Irritability

    • Hematemesis

    • Hypotension

    • Shock

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Laboratory Findings

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  • • Heme positive stool (if ischemia present)

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Imaging Findings

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  • Abdominal x-ray: Shows proximal duodenal and gastric distention with paucity of gas distally

    Upper GI series: Shows duodenojejunal junction to right of midline and some duodenal narrowing

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Rule Out

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  • • Volvulus with ischemia by emergent laparotomy if malrotation is suspected and symptomatic

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  • • History and physical exam

    • Abdominal x-ray

    • Upper GI series

    • Fecal hemoccult test

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Surgery

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  • • Ladd procedure, resection of any necrotic bowel, and appendectomy

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Complications

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  • • Small bowel obstruction in 1-10%

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Prognosis

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  • • Excellent

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References

Bass KD, Rothenberg SS, Chang JH: Laparoscopic Ladd’s procedure in infants with malrotation. J Pediatr Surg 1998;33:279.  [PubMed: 9498402]
Prasil P et al: Should malrotation in children be treated differently according to age? J Pediatr Surg 2000;35:756.  [PubMed: 10813343]
Rescorla F et al: Anomalies of intestinal rotation in childhood: analysis of 447 cases. Surgery 1990;108:710.  [PubMed: 2218883]
Torres AM, Ziegler MM: Malrotation of the intestine. World J Surg 1993;17:326.  [PubMed: 8337878]

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