Overview
Malrotation of the intestine with midgut volvulus is a congenital anomaly characterized by abnormal positioning and fixation of the intestines, often leading to obstruction and twisting of the midgut around the superior mesenteric artery, causing ischemia and potential necrosis 2.Diagnosis
Clinical Presentation: Symptoms include bilious vomiting, abdominal distension, and in severe cases, shock and peritonitis 2.
Imaging: Abdominal X-ray may show a "whirl sign" indicative of volvulus; contrast studies like upper GI series can reveal malrotation 2.
Endoscopy: Small bowel biopsy may be considered in cases of unexplained diarrhea or malabsorption, though carries risks like bleeding from varices 2.Management
Surgical Intervention: Ladd procedure (resection of Ladd bands, widening of the mesenteric base, and fixation of the duodenum) is the definitive treatment 2.
Supportive Care: Fluid resuscitation, electrolyte management, and monitoring for complications such as bowel necrosis or perforation 2.Special Populations
Pediatrics: Most common in neonates and infants; early diagnosis and surgical intervention are critical 2.
Complications: Mesenteric vascular occlusion and gastrointestinal bleeding from varices can occur, necessitating vigilant monitoring 2.Key Recommendations
Surgical Correction: Immediate surgical intervention with the Ladd procedure is essential for definitive management of malrotation with volvulus (Evidence: Strong 2).
Consider Varices: Evaluate for and manage gastrointestinal bleeding due to varices, especially in cases where endoscopy or biopsy is planned (Evidence: Moderate 2).
Early Imaging: Utilize imaging studies, particularly upper GI series, for early diagnosis and to identify characteristic signs like the whirl sign (Evidence: Moderate 2).References
1 Bonfanti P, Colombo A, Heintzelman MB, Mooseker MS, Camatini M. The molecular architecture of an insect midgut brush border cytoskeleton. European journal of cell biology 1992. link
2 Park RW, Watkins JB. Mesenteric vascular occlusion and varices complicating midgut malrotation. Gastroenterology 1979. link