Intestinal malrotation

Last reviewed: 20 Apr 2022
Last updated: 27 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • bilious vomiting
  • abdominal pain
More key diagnostic factors

Other diagnostic factors

  • infant age <1 year
  • normal abdominal exam
  • abdominal distension
  • abdominal tenderness
  • tachycardia with hypertension
  • tachycardia with hypotension
  • tachypnea
  • weight loss
  • dark blood in diaper
  • rebound tenderness and guarding
Other diagnostic factors

Risk factors

  • embryologic abnormality
More risk factors

Diagnostic investigations

1st investigations to order

  • upper gastrointestinal contrast series
  • CT abdomen (with oral and intravenous [IV] contrast)
  • abdominal plain films
  • CBC
More 1st investigations to order

Investigations to consider

  • ultrasound
  • lower gastrointestinal (GI) contrast series
  • ABG
More investigations to consider

Treatment algorithm

INITIAL

obstruction with ischemia

ACUTE

obstruction without ischemia

intermittent or partial volvulus or obstructing Ladd bands

questionable malrotation or asymptomatic finding

Contributors

Authors

Michael Stanton, MB BS, MD, FRCS (Paed Surg)

Consultant Paediatric Surgeon and Honorary Senior Lecturer

Department of Paediatric Surgery

University Hospital Southampton

Southampton

UK

Disclosures

MS acts as an expert witness and writes reports for medico-legal cases on an ad hoc basis.

Acknowledgements

Dr Michael Stanton would like to gratefully acknowledge Dr Stephen Shew, Dr S.D. St Peter, Dr Fizan Abdullah, and Dr Omar Karim, previous contributors to this topic.

Disclosures

SS is the author of two references cited in this topic. SDSP is the co-author of one reference cited in this topic. FA and OK declared that they had no competing interests. FA and OK declared that they had no competing interests.

Peer reviewers

Casey M. Calkins, MD

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.

Steve Rothenberg, MD

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.

KuoJen Tsao, MD

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.

Eric Nicholls, MD

Consultant Paediatric Surgeon

Paediatric Surgery

St George's Hospital

London

UK

Disclosures

EN declares that he has no competing interests.

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