Overview

• Malrotation → abnormal development of the midgut during embryogenesis. This makes bowel more susceptible to volvulus.
  • Process of rotation and fixation of midgut takes place during 4th to 12th weeks of gestation.
• Volvulus (complication of malrotation) → life-threatening condition characterised by bowel twisting, and duodenal compression by peritoneal bands (Ladd bands).

Making Diagnosis

Clinical Features

• Bilious Vomiting → often within first day of life.
  • Occurs if obstruction is below the ampulla of vater (where the hepatopancreatic duct joins the duodenum).
• Distended abdomen.

<aside> 💡 Infant with bilious vomiting and obstruction → intestinal malrotation.

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Investigations

• Upper GI Contrast Study → gold standard. Will reveal obstruction point as no contrast can pass distally from this location. Proximal bowel may demonstrate corkscrew appearance.

Management Plan

• Signs of Vascular Compromise → emergency laparotomy.
• Ladd Procedure → detorting the bowel and surgically dividing the Ladd band. Can be done laparoscopically or open.
• Antibiotics → cefazolin.

Complications →