Highlights & Basics
- Intestinal malrotation is an entire spectrum of rotational and fixation disturbances that can occur during embryonic development.
- The anatomic variant that poses the highest risk of volvulus is a narrow midgut mesenteric base accompanied by lack of retroperitoneal midgut fixation. This variant cannot be reliably determined from any radiologic studies.
- Malrotation predisposes patients to a risk of midgut volvulus.
- Emergency surgical consultation is appropriate before obtaining any diagnostic studies if midgut volvulus is suspected. Upper gastrointestinal contrast studies should be ordered in patients who are stable.
- Treatment is surgical correction, the procedure of choice being the Ladd procedure.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Citations
Shew SB. Surgical concerns in malrotation and midgut volvulus. Pediatr Radiol. 2009;39(suppl 2):S167-S171.[Abstract]
Applegate KE. Evidence-based diagnosis of malrotation and volvulus. Pediatr Radiol. 2009;39(suppl 2):S161-S163.[Abstract]
Powell D, Othersen JB, Smith CD. Malrotation of the intestines in children: the effect of age on presentation and therapy. J Pediatr Surg. 1989;24:777-780.[Abstract]
Stewart DR, Colodny AL, Daggett WC. Malrotation of the bowel in infants and children: a 15 year review. Surgery. 1976;19:716-720.[Abstract]
1. Kantor JL. Anomalies of the colon: their roentgen diagnosis and clinical significance: Resume of 10 years study. Radiology. 1934;23:651-662.
2. Skandalakis JE, Gray SW, Ricketts R, et al. The small intestines. In: Skandalakis JE, Gray SW, eds. Embryology for surgeons, 2nd ed. Baltimore, MD: Williams & Wilkins; 1994:184.
3. Byrne WJ. Disorders of the intestine and pancreas. In: Taeusch WH, Ballard RA, Avery ME, eds. Disease of the newborn. Philadelphia, PA: WB Saunders; 1991:586-693.
4. Gray SW, Skandalakis JE. Embryology for surgeons. Philadelphia, PA: WB Saunders; 1972:129-141.
5. Sadler TW. Langman's medical embryology, 7th Ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1995:258-267.
6. Gross RE. Malrotation of the intestine and colon. In: Gros RE, ed. The surgery of infancy and childhood. Philadelphia, PA: WB Saunders; 1953:192.
7. Shew SB. Surgical concerns in malrotation and midgut volvulus. Pediatr Radiol. 2009;39(suppl 2):S167-S171.[Abstract]
8. Applegate KE. Evidence-based diagnosis of malrotation and volvulus. Pediatr Radiol. 2009;39(suppl 2):S161-S163.[Abstract]
9. Kirks DR, Caron KJ. Gastrointestinal tract. In: Kirks DR, ed. Practical pediatric imaging, 2nd ed. Philadelphia, PA: JB Lippincott; 1991:710.
10. Daneman A. Malrotation: the balance of evidence. Pediatr Radiol. 2009;39(suppl 2):S164-S166.[Abstract]
11. Powell D, Othersen JB, Smith CD. Malrotation of the intestines in children: the effect of age on presentation and therapy. J Pediatr Surg. 1989;24:777-780.[Abstract]
12. Yu DC, Thiagarajan RR, Laussen PC, et al. Outcomes after the Ladd procedure in patients with heterotaxy syndrome, congenital heart disease, and intestinal malrotation. J Pediatr Surg. 2009;44:1089-1095.[Abstract]
13. Tsao KJ, St Peter SD, Valusek PA, et al. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg. 2007 Jun;42(6):939-42;discussion 942.[Abstract]
14. Ooms N, Matthyssens LE, Draaisma JM, et al. Laparoscopic Treatment of Intestinal Malrotation in Children. Eur J Pediatr Surg. 2016 Aug;26(4):376-81.[Abstract][Full Text]
15. Fraser JD, Aguayo P, Sharp SW, et al. The role of laparoscopy in the management of malrotation. J Surg Res. 2009;156:80-82.[Abstract]
16. Lessin MS, Luks FI. Laparoscopic appendectomy and duodenocolonic dissociation (LADD) procedure for malrotation. Pediatr Surg Int. 1998;13:184-185.[Abstract]
17. Mazziotti MV, Strasberg SM, Langer JC. Intestinal rotation abnormalities without volvulus: the role of laparoscopy. J Am Coll Surg. 1997;185:172-176.[Abstract]
18. Draus JM Jr, Foley DS, Bond SJ. Laparoscopic Ladd procedure: a minimally invasive approach to malrotation without midgut volvulus. Am Surg. 2007;73:693-696.[Abstract]
19. NHS Improvement. Patient Safety review and response: April to September 2018. March 2019 [internet publication].[Full Text]
20. NHS England. Patient safety alert on placement devices for nasogastric tube insertion. December 2019 [internet publication].[Full Text]
21. Warner BW. Malrotation. In: Oldham KT, Colambani PM, Foglia RP, eds. Surgery of infants and children: scientific principles and practice. Philadelphia, PA: Lippincott-Raven; 1997:1229-1240.
22. Stewart DR, Colodny AL, Daggett WC. Malrotation of the bowel in infants and children: a 15 year review. Surgery. 1976;19:716-720.[Abstract]
23. Jen HC, Shew SB. Laparoscopic versus open appendectomy in children: outcomes comparison based on a statewide analysis. J Surg Res. 2010;161:13-17.[Abstract]
