Malrotation with Volvulus

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Malrotation with Volvulus
Malrotation with Volvulus

image by: Keeras Malrotation

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Consider Malrotation in patients with vomiting with or WITHOUT abdominal distension...

Presentation of Malrotation

  • The Neonate (<30 days of age)
  • Most malrotation present in this population.
  • ~50% will present in first week of life and more than 60% before the end of the 1st month.
  • Bilious emesis is the most frequent symptom (but not the sine qua non).
  • Pain and irritability are not prominent clinical features in the neonate!
  • Abdomen is soft and not tender (until there is strangulation).

The older child

  • 20% develop symptoms after…

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The Neonate (<30 days of age) - Most malrotation present in this population.

Core EM

Depending on the progression of the strangulation an abdominal X-ray will show evidence of small bowel obstruction or lack of any gas in the abdomen. Free air may be seen due to ischemic bowel perforation.

Nationwide Children's

Most children with this condition have symptoms within the first year of life. Some people who have malrotation go their whole lives without having any symptoms and are never diagnosed. Other people may not have symptoms until adolescence or adulthood.


Experts are not sure how common malrotation is because not all people with malrotation develop signs or symptoms. Some studies suggest that about 1 in 500 people have malrotation.


Midgut volvulus can happen at any age, but most commonly occurs during the first few weeks of life. Bilious emesis is usually the first feature of volvulus. Infants that present with sudden-onset bilious vomiting, upper abdominal distension, and abdominal tenderness associated with hemodynamic deterioration must be rapidly evaluated to ensure that they do not have intestinal malrotation along with volvulus.

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