- Mary L Brandt, MD
Mary L Brandt, MD
- Professor of Surgery, Division of Pediatric Surgery
- Baylor College of Medicine
- Section Editors
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- George D Ferry, MD
George D Ferry, MD
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- Baylor College of Medicine
Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut. They are often associated with other gastrointestinal abnormalities, particularly those in which the intestines are located outside the coelomic cavity (eg, congenital diaphragmatic hernia or abdominal wall defects). However, intestinal malrotation can also occur in children and adults who have no associated anomalies.
An overview of the presentation, diagnosis, and treatment of intestinal malrotation will be presented here. Congenital diaphragmatic hernia and abdominal wall defects are discussed separately. (See "Omphalocele".)
Rotational anomalies, which may or may not be symptomatic, are estimated to occur in between 1 in 200 and 1 in 500 live births [1,2]. Symptomatic malrotation is estimated to occur in 1 in 6000 live births . Traditionally, intestinal malrotation has been considered primarily a disease of infancy with infrequent occurrence beyond the first year of life. However, analysis of 2744 cases of intestinal rotation in children up to 17 years of age obtained from a national hospital discharge database found the following :
●Presentation by one month of age: 30 percent
●Presentation before one year of age: 58 percent
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- Dufour D, Delaet MH, Dassonville M, et al. Midgut malrotation, the reliability of sonographic diagnosis. Pediatr Radiol 1992; 22:21.
- Pracros JP, Sann L, Genin G, et al. Ultrasound diagnosis of midgut volvulus: the "whirlpool" sign. Pediatr Radiol 1992; 22:18.
- Ashley LM, Allen S, Teele RL. A normal sonogram does not exclude malrotation. Pediatr Radiol 2001; 31:354.
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- Normal gut development
- Abnormal gut development
- CLINICAL PRESENTATION
- General considerations
- Duodenal obstruction
- Other presentations
- CONFIRMATORY STUDIES
- Plain radiographs
- Upper GI series
- Barium enema
- Computed tomography
- DIFFERENTIAL DIAGNOSIS
- Symptomatic malrotation
- - Laparoscopy
- Asymptomatic malrotation
- - Short gut syndrome
- - Small bowel obstruction
- Resolution of symptoms
- Recurrent volvulus
- SUMMARY AND RECOMMENDATIONS