Skip to Main Content

  • • 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


  • • 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


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


  • • Small bowel obstruction in 1-10%


  • • Excellent


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]

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.