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Malrotation
Steven J. Kraus, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Malfixation
            • Definitions

              • Malrotation: Varying degrees of abnormal positioning of small &/or large bowel due to abnormal rotation during development
                • Small & large bowel rotate separately in utero
                • Abnormalities of rotation may affect either or both
              • Malfixation: Abnormal position or length of bowel fixation by mesentery, typically associated with malrotation
                • Predisposes to midgut volvulus (MV)

            IMAGING

            • General Features

              • Radiographic Findings

                • Fluoroscopic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Abbas PI et al: Evaluating a management strategy for malrotation in heterotaxy patients. J Pediatr Surg. 51(5):859-62, 2016
                                                2. Carroll AG et al: Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol. 23(5):559-68, 2016
                                                3. Drewett M et al: The burden of excluding malrotation in term neonates with bile stained vomiting. Pediatr Surg Int. 32(5):483-6, 2016
                                                4. Eccleston JL et al: Adult presentation of intestinal malrotation. J Gastroenterol Hepatol. ePub, 2016
                                                5. Koch C et al: Redefining the projectional and clinical anatomy of the duodenojejunal flexure in children. Clin Anat. 29(2):175-82, 2016
                                                6. Kotobi H et al: Intestinal volvulus related to malrotation in adults. Int J Colorectal Dis. ePub, 2016
                                                7. Lesieur E et al: Prenatal diagnosis of complete nonrotation of fetal bowel with ultrasound and magnetic resonance imaging. Diagn Interv Imaging. 97(6):687-9, 2016
                                                8. Morris G et al: Small bowel congenital anomalies: a review and update. Curr Gastroenterol Rep. 18(4):16, 2016
                                                9. Raitio A et al: Malrotation: age-related differences in reoperation rate. Eur J Pediatr Surg. 26(1):34-7, 2016
                                                10. Yoshimaru K et al: Clinical analysis of 70 bowel obstruction patients without a history of laparotomy. Pediatr Int. ePub, 2016
                                                11. Arlt A et al: Abdominal malrotation overlooked at extensive cross-sectional imaging and leading to life-threatening gastrointestinal bleeding. Endoscopy. 47 Suppl 1:E639-40, 2015
                                                12. Chesley PM et al: Association of anorectal malformation and intestinal malrotation. Am J Surg. 209(5):907-11; discussion 912, 2015
                                                13. Gemmell A: Partial malrotation of the bowel in an adult patient presenting with abdominal pain. BMJ Case Rep. 2015, 2015
                                                14. Graziano K et al: Asymptomatic malrotation: diagnosis and surgical management: an American Pediatric Surgical Association outcomes and evidence based practice committee systematic review. J Pediatr Surg. 50(10):1783-90, 2015
                                                15. Jadhav RR et al: Adult intestinal malrotation presenting as recurrent vomiting: a case report. Indian J Surg. 77(Suppl 1):162-3, 2015
                                                16. Landisch R et al: Observation versus prophylactic Ladd procedure for asymptomatic intestinal rotational abnormalities in heterotaxy syndrome: A systematic review. J Pediatr Surg. 50(11):1971-4, 2015
                                                17. Lodwick DL et al: Current surgical management of intestinal rotational abnormalities. Curr Opin Pediatr. 27(3):383-8, 2015
                                                18. Mishra S: Cardiac and non-cardiac abnormalities in heterotaxy syndrome. Indian J Pediatr. 82(12):1135-46, 2015
                                                19. Mitsunaga T et al: Risk factors for intestinal obstruction after Ladd procedure. Pediatr Rep. 7(2):5795, 2015
                                                20. Ooms N et al: Laparoscopic treatment of intestinal malrotation in children. Eur J Pediatr Surg. ePub, 2015
                                                21. Prasad GR et al: Malrotation of midgut in adults, an unsuspected and neglected condition-An analysis of 64 consensus confirmed cases. Indian J Gastroenterol. 34(6):426-30, 2015
                                                22. Rajesh S et al: Malrotation of small bowel-diagnostic computed tomography (CT) signs and intraoperative findings. Indian J Surg. 77(Suppl 2):600-2, 2015
                                                23. Shah MR et al: Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus. Pediatr Radiol. 45(13):1953-6, 2015
                                                24. Zhou LY et al: Usefulness of sonography in evaluating children suspected of malrotation: comparison with an upper gastrointestinal contrast Study. J Ultrasound Med. 34(10):1825-32, 2015
                                                25. Yang B et al: Adult midgut malrotation: multi-detector computed tomography (MDCT) findings of 14 cases. Jpn J Radiol. 31(5):328-35, 2013
                                                26. Jamieson D et al: Malrotation and malfixation of the midgut: pediatric gastrointestinal imaging and intervention, 2e. Stringer and Babyn, B. C. Decker, Inc, Ontario. 311-332, 2000
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Malfixation
                                                          • Definitions

                                                            • Malrotation: Varying degrees of abnormal positioning of small &/or large bowel due to abnormal rotation during development
                                                              • Small & large bowel rotate separately in utero
                                                              • Abnormalities of rotation may affect either or both
                                                            • Malfixation: Abnormal position or length of bowel fixation by mesentery, typically associated with malrotation
                                                              • Predisposes to midgut volvulus (MV)

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • Fluoroscopic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Abbas PI et al: Evaluating a management strategy for malrotation in heterotaxy patients. J Pediatr Surg. 51(5):859-62, 2016
                                                                                              2. Carroll AG et al: Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol. 23(5):559-68, 2016
                                                                                              3. Drewett M et al: The burden of excluding malrotation in term neonates with bile stained vomiting. Pediatr Surg Int. 32(5):483-6, 2016
                                                                                              4. Eccleston JL et al: Adult presentation of intestinal malrotation. J Gastroenterol Hepatol. ePub, 2016
                                                                                              5. Koch C et al: Redefining the projectional and clinical anatomy of the duodenojejunal flexure in children. Clin Anat. 29(2):175-82, 2016
                                                                                              6. Kotobi H et al: Intestinal volvulus related to malrotation in adults. Int J Colorectal Dis. ePub, 2016
                                                                                              7. Lesieur E et al: Prenatal diagnosis of complete nonrotation of fetal bowel with ultrasound and magnetic resonance imaging. Diagn Interv Imaging. 97(6):687-9, 2016
                                                                                              8. Morris G et al: Small bowel congenital anomalies: a review and update. Curr Gastroenterol Rep. 18(4):16, 2016
                                                                                              9. Raitio A et al: Malrotation: age-related differences in reoperation rate. Eur J Pediatr Surg. 26(1):34-7, 2016
                                                                                              10. Yoshimaru K et al: Clinical analysis of 70 bowel obstruction patients without a history of laparotomy. Pediatr Int. ePub, 2016
                                                                                              11. Arlt A et al: Abdominal malrotation overlooked at extensive cross-sectional imaging and leading to life-threatening gastrointestinal bleeding. Endoscopy. 47 Suppl 1:E639-40, 2015
                                                                                              12. Chesley PM et al: Association of anorectal malformation and intestinal malrotation. Am J Surg. 209(5):907-11; discussion 912, 2015
                                                                                              13. Gemmell A: Partial malrotation of the bowel in an adult patient presenting with abdominal pain. BMJ Case Rep. 2015, 2015
                                                                                              14. Graziano K et al: Asymptomatic malrotation: diagnosis and surgical management: an American Pediatric Surgical Association outcomes and evidence based practice committee systematic review. J Pediatr Surg. 50(10):1783-90, 2015
                                                                                              15. Jadhav RR et al: Adult intestinal malrotation presenting as recurrent vomiting: a case report. Indian J Surg. 77(Suppl 1):162-3, 2015
                                                                                              16. Landisch R et al: Observation versus prophylactic Ladd procedure for asymptomatic intestinal rotational abnormalities in heterotaxy syndrome: A systematic review. J Pediatr Surg. 50(11):1971-4, 2015
                                                                                              17. Lodwick DL et al: Current surgical management of intestinal rotational abnormalities. Curr Opin Pediatr. 27(3):383-8, 2015
                                                                                              18. Mishra S: Cardiac and non-cardiac abnormalities in heterotaxy syndrome. Indian J Pediatr. 82(12):1135-46, 2015
                                                                                              19. Mitsunaga T et al: Risk factors for intestinal obstruction after Ladd procedure. Pediatr Rep. 7(2):5795, 2015
                                                                                              20. Ooms N et al: Laparoscopic treatment of intestinal malrotation in children. Eur J Pediatr Surg. ePub, 2015
                                                                                              21. Prasad GR et al: Malrotation of midgut in adults, an unsuspected and neglected condition-An analysis of 64 consensus confirmed cases. Indian J Gastroenterol. 34(6):426-30, 2015
                                                                                              22. Rajesh S et al: Malrotation of small bowel-diagnostic computed tomography (CT) signs and intraoperative findings. Indian J Surg. 77(Suppl 2):600-2, 2015
                                                                                              23. Shah MR et al: Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus. Pediatr Radiol. 45(13):1953-6, 2015
                                                                                              24. Zhou LY et al: Usefulness of sonography in evaluating children suspected of malrotation: comparison with an upper gastrointestinal contrast Study. J Ultrasound Med. 34(10):1825-32, 2015
                                                                                              25. Yang B et al: Adult midgut malrotation: multi-detector computed tomography (MDCT) findings of 14 cases. Jpn J Radiol. 31(5):328-35, 2013
                                                                                              26. Jamieson D et al: Malrotation and malfixation of the midgut: pediatric gastrointestinal imaging and intervention, 2e. Stringer and Babyn, B. C. Decker, Inc, Ontario. 311-332, 2000