Malrotation

• • 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

Epidemiology

• • 5% incidence of some variant in population

Symptoms and Signs

• • Bilious emesis

  • Abdominal distention

  • Feeding intolerance

  • Irritability

  • Hematemesis

  • Hypotension

  • Shock

Laboratory Findings

• • Heme positive stool (if ischemia present)

Imaging Findings

• • 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

Rule Out

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

• • History and physical exam

  • Abdominal x-ray

  • Upper GI series

  • Fecal hemoccult test

Surgery

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

Complications

• • Small bowel obstruction in 1-10%

Prognosis

• • Excellent

References