Malrotation is a congenital anomaly in which the midgut undergoes abnormal rotation and fixation during embryogenesis. This misplacement of the gut makes it susceptible to volvulus, a life-threatening condition characterized by bowel twisting, and duodenal compression by peritoneal bands, known as Ladd bands.

Epidemiology

• Though considered a rare condition, malrotation is critical due to its potential life-threatening complications.
• The exact incidence is difficult to ascertain due to many asymptomatic cases; however, symptomatic malrotation most commonly presents in neonates.

Aetiology

• Malrotation arises due to abnormal rotation and fixation of the midgut during embryonic development.
• This process usually happens during the 4th to 12th weeks of gestation.
• Genetic factors may play a role, although the exact aetiology is still unclear.

Pathophysiology

• High caecum at the midline
• Feature in exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia
• May be complicated by the development of volvulus, an infant with volvulus may have bile stained vomiting

PC

• Often occurs in the first day of life
• Infant with bilious vomiting & obstruction → ?intestinal malrotation