Intestinal malrotation and volvulus

Abstract Malrotation refers to anomalies of fixation at the duodenojejunal flexure, which, when associated with a mobile caecum, can result in a short, unstable mesentery that may twist (volve). Ladd’s bands may cross the duodenum, causing obstruction. A volvulus may present with bilious vomiting and a scaphoid, gasless abdomen. If a bilious vomit is the only feature, imaging is appropriate, but if vascular compromise is suspected (enteral bleeding, abdominal tenderness, or acidosis), then emergency laparotomy is mandated. Obstruction due to malrotation usually presents in the first days of life but can be seen later. A Ladd’s procedure broadens the mesentery and places the intestine in a non-rotated position. Malrotation is associated with many and various anomalies. Controversies to consider include: imaging modalities and their timing; management of asymptomatic malrotation; and prophylactic appendicectomy during a Ladd’s procedure. Determining intestinal stability is the challenge for the future.