Malrotation may present as midgut vovulus, vomiting, or asymptomatic. Midgut
volvulus can occur in anatomic configurations where the root of the mesentery is
narrow. In the course of the regular peristatlsis of the gut, the intestine twists in a
clockwise fashion. Bilious vomiting is the classic presentation of volvulus, and as such,
all babies with green or bright yellow emesis should have an urgen upper GI study. If a
volvulus is diagnosed, this requires an EMERGENT EXPLORATORY LAPAROTOMY!.
Vomiting may also occur due to abnormal adhesions from the retroperitoneum
which can tether the duodenum, causing a partial obstruction. The surgical correction of
Ladd’s bands is not as urgent as reduction of volvulus.
Sometimes, malrotation is diagnosed from an upper Gi series and is asymptomatic. A
Ladd’s procedure is still required, but on a more elective basis.
Work-Up
Plain film of abdomen- distended, air-filled loops of bowel
Upper GI study- establish position of duodenal junction (Ligament of Treitz); rule out
volvulus
Treatment: Timing of surgical intervention is dependent on the sitution. Volvulus
requires emergent laparotomy. Partial obstruction due to Ladd’s bands or asymptomatic
rotational anomaly may be repaired on a more elective basis.
LADD’S PROCEDURE:
- Right upper quadrant transverse incision.
- If volvulized bowel, detorse in a counterclockwise manner until the mesentery is
straight. Make sure that the anesthesiologist knows that the bowel is getting