Congenital Intestinal Malrotation: A Narrative Review of Age-specific Presentations, Evolving Diagnostics and Surgical Innovations

Congenital intestinal malrotation is a developmental anomaly resulting from incomplete or aberrant rotation and fixation of the midgut during embryogenesis. Normally, the midgut rotates 270 degrees around the Superior Mesenteric Artery (SMA); any deviation from this normal rotation leads to abnormal positioning of the Duodenojejunal Junction (DJJ) and caecum. In neonates and infants, the condition is characterised by bilious vomiting, abdominal distension, and failure to thrive. In older children, it may present with chronic abdominal pain and intermittent vomiting. Adults often exhibit nonspecific Gastrointestinal (GI) symptoms or atypical features resembling pancreatitis, which commonly leads to delayed diagnosis. The Ladd procedure remains the gold-standard surgical intervention, although newer restorative techniques are emerging. Outcomes depend largely on prompt diagnosis and timely surgical management, with current recommendations emphasising early recognition, operative treatment, and appropriate follow-up to minimise morbidity and mortality.