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Highlights & Basics
- For those with intestinal malrotation, 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.
- The presence of bilious (dark green) vomiting is a key factor in considering the possibility of midgut volvulus. Prompt discussion with a pediatric surgeon is advised in this scenario to ensure timely referral, investigation, and management.
- 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 a Ladd procedure.
Quick Reference
History & Exam
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Definition
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Citations
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Expert Panel on Pediatric Imaging, Alazraki AL, Rigsby CK, et al. ACR appropriateness criteria® vomiting in infants. J Am Coll Radiol. 2020 Nov;17(11s):S505-15.[Abstract][Full Text]
Graziano K, Islam S, Dasgupta R, et al. Asymptomatic malrotation: diagnosis and surgical management: an American Pediatric Surgical Association outcomes and evidence based practice committee systematic review. J Pediatr Surg. 2015 Oct;50(10):1783-90.[Abstract]
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]
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