Article Sections

Introduction

Malrotation is a congenital anomaly in which the intestines undergo incomplete physiologic rotation during embryological development.  Complications include intestinal obstruction and/or volvulus with classic manifestations of bilious emesis in infancy.

Pathogenesis

At 4-6 weeks gestation ( video 1), the midgut undergoes rapid growth that cannot be accommodated by the embryonic abdominal cavity.  It therefore physiologically herniates through the umbilical ring while undergoing a 90-degree counterclockwise rotation.  It returns to the abdominal cavity by 10-11 weeks gestation and turns an additional 180 degrees (270 degrees counterclockwise total).  This rotation allows the intestines to attach to the parietal peritoneum of the posterior abdominal wall, creating a wide mesenteric base that extends from the duodenojejunal flexure (attached via the ligament of Treitz) in the left upper quadrant to the cecum in the right lower quadrant (

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