Intestinal malrotation

Intestinal malrotation is a congenital anomaly of rotation of the midgut. It occurs during the first trimester as the fetal gut undergoes a complex series of growth and development. Malrotation can lead to a dangerous complication called volvulus, in which cases emergency surgery is indicated. Malrotation can refer to a spectrum of abnormal intestinal positioning, often including:

• The small intestine found predominantly on the right side of the abdomen
• The cecum displaced from its usual position in the right lower quadrant into the epigastrium or right hypochondrium
• An absent or displaced ligament of Treitz
• Fibrous peritoneal bands called bands of Ladd running across the vertical portion of the duodenum
• An unusually narrow, stalk-like mesentery

The position of the intestines, narrow mesentery and Ladd's bands can contribute to several severe gastrointestinal conditions. The narrow mesentery predisposes some cases of malrotation to midgut volvulus, a twisting of the entire small bowel that can obstruct the mesenteric blood vessels leading to intestinal ischemia, necrosis, and death if not promptly treated. The fibrous Ladd's bands can constrict the duodenum, leading to intestinal obstruction.