Summary
Definition
Intestinal malrotation is a term used to describe an entire spectrum of rotational and fixation disturbances that can occur during embryonic development.
Abnormal caecal attachments to the right upper peritoneal cavity (i.e., Ladd’s bands) can cross the second portion of the duodenum creating an extraluminal low-grade obstruction of the duodenum, which may present with signs of partial obstruction. However, the most significant pathological concerns in malrotation are a lack of intestinal fixation to the retro-peritoneum and a narrow midgut mesenteric base that predisposes to a twisting of the small bowel in the form of midgut volvulus. This condition creates an abrupt obstruction of the duodenum, resulting in bilious vomiting.
[Figure caption and citation for the preceding image starts]:
Malrotation with volvulus causing complete obstruction of the duodenum that does not sweep to the left, as seen on upper GI contrast
From the collection of Dr S.D. St Peter
[Citation ends].
If the twisting at the base also obstructs flow in the superior mesenteric artery, the entire small intestine and proximal colon may become acutely ischaemic and subsequently necrotic within a few hours.
Patients with malrotation are at risk for volvulus and should be identified whenever possible to allow for proper therapy.
History and exam
Other diagnostic factors
- infant age <1 year
- normal abdominal examination
- abdominal distension
- abdominal tenderness
- tachycardia with hypertension
- tachycardia with hypotension
- tachypnoea
- weight loss
- dark blood in nappy
- rebound tenderness and guarding
Diagnostic investigations
1st investigations to order
- upper GI contrast series
- CT abdomen (with oral and IV contrast)
- abdominal plain x-rays
- FBC
Treatment algorithm
Contributors
Authors VIEW ALL
Pediatric Surgery Division Head & Vice Chair Department of Surgery
Program Director, Fellowship in Pediatric Surgery
Ann & Robert H. Lurie Children's Hospital of Chicago
Professor of Surgery
Northwestern University Feinberg School of Medicine
Chicago
IL
Disclosures
FA declares that he has no competing interests.
Clinical Fellow in Surgery
Harvard Medical School
Boston
MA
Disclosures
OK declares that he has no competing interests.
Dr Fizan Abdullah and Dr Omar Karim would like to gratefully acknowledge Dr Stephen Shew and Dr S.D. St Peter, previous contributors to this monograph. SS is the author of two references cited in this monograph. SDSP is the co-author of one reference cited in this monograph.
Peer reviewers VIEW ALL
Assistant Professor of Pediatric Surgery
The Medical College of Wisconsin
Children's Hospital and Health System
Milwaukee
WI
Disclosures
CC declares that he has no competing interests.
Chief of Pediatric Surgery
Chairman Department of Pediatrics
The Rocky Mountain Hospital for Children at Presbyterian/St. Luke's
Denver
CO
Disclosures
SR declares that he has no competing interests.
Assistant Professor
Department of Pediatric Surgery
University of Texas Health Science Center at Houston
Houston
TX
Disclosures
KT declares that he has no competing interests.
Consultant Paediatric Surgeon
Paediatric Surgery
St George's Hospital
London
UK
Disclosures
EN declares that he has no competing interests.
Use of this content is subject to our disclaimer