Intestinal malrotation is a congenital anomaly of rotation of the midgut where the small bowel is found on the right side of the abdomen and the caecum is found in the subpyloric region. Since the intestines are attached by a narrow base, the midgut is prone to twisting (or volvulus), which can obstruct the mesenteric vessels and cause intestinal ischemia.

Presentation

Patients present acutely with bilious vomiting, cramping abdominal pain, abdominal distention , and the passage of blood and mucus in their stool. Patients with chronic, uncorrected malrotation will show recurrent abdominal pain and vomiting.

Diagnosis

With acutely ill patients, consider an emergency exploratory laparotomy if there is a high index of suspicion. An upper GI series will demonstrate a gasless abdomen, evidence of intestinal obstruction, and gastric or duodenal distention.

Treatment

Resuscitate the patient with fluids to stabilize them before correcting the malrotation with surgery.