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Malrotation and Midgut Volvulus

Malrotation is a general term that includes a wide spectrum of anomalies that occur when intestinal rotation and fixation happens in an abnormal way. Failure of completion of the normal intestinal rotation leads to a continuum of anatomic abnormalities with a common clinical denominator consisting of obstruction with the potential for midgut volvulus. Only its presentation as an abdominal emergency in the neonatal period is discussed here.

Malrotation results not only in the malposition of the bowel but also in the malfixation of the mesentery. When the duodenojejunal junction and the cecum, the normal points of fixation of the mesentery, are not in their usual location, the mesen-teric attachment is shortened to a narrow pedicle. Because the entire length of the midgut is attached to this narrow pedicle, there is a tendency for the intestines to twist around the pedicle. This twisting of malfixed intestines around the short mesentery is named midgut volvulus (Fig. 1.7) (Millar et al. 2003; Torres and Ziegler 1993). With volvulus, the small bowel wraps around the axis of the superior mesenteric artery (SMA), resulting in a spiral that impairs blood supply. Twists of 720° and greater are often reported. Increasing degrees of volvulus will

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