Intestinal malrotation

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Intestinal malrotation is a congenital anomaly of rotation of the midgut (embryologically, the gut undergoes a complex rotation outside the abdomen). As a result:

the small bowel is found predominantly on the left side of the abdomen
the cecum is found in the epigastrium - right hypochondrium
there is no angle of Treitz
fibrous bands (of Ladd) course over the horizontal part of the duodenum (DII), causing intestinal obstruction.
the intestines are attached by a narrow base, and therefore the midgut is prone to twisting (or volvulus). This can obstruct the mesenteric vessels and cause intestinal ischemia.

This can lead to a number of disease manifestations such as:

acute midgut volvulus
chronic midgut volvulus
acute duodenal obstruction
chronic duodenal obstruction
internal herniation

[edit] Presentation

Patients present acutely with bilious vomiting, cramping abdominal pain, abdominal distention, and the passage of blood and mucus in their stool. Patients with chronic, uncorrected malrotation will show recurrent abdominal pain and vomiting.

[edit] Diagnosis

With acutely ill patients, consider an emergency exploratory laparotomy if there is a high index of suspicion. An upper GI series will demonstrate a gasless abdomen, evidence of intestinal obstruction, and gastric or duodenal distention. On contrast enema, the caecum can be seen at an abnormal location.