Infants most commonly present with midgut volvulus, a life-threatening complication of intestinal malrotation characterized by proximal bowel obstruction and ischemia.
- Acute midgut volvulus – The typical presentation involves a neonate or infant with acute onset of bilious vomiting and diffuse abdominal pain that is out of proportion to exam findings.
- Chronic midgut volvulus – Occurs due to incomplete twisting from lymphatic and venous obstruction. The typical presentation involves a patient with recurring abdominal pain and malabsorption syndrome. Other clinical symptoms include recurring diarrhea and constipation, obstructive jaundice, solid food intolerance, and gastroesophageal reflux.
Older children or adults usually present with episodes of duodenal obstruction that may spontaneously resolve. These patients may also present with internal hernias. Common symptoms include abdominal distension, abdominal pain, bloody stools, shock, tachypnea, and vomiting (with or without bile).
Some individuals may live their whole lives healthy and asymptomatically. However, having intestinal malrotation predisposes patients to life-threatening complications of midgut volvulus and intestinal obstructions.
Malrotation with volvulus or obstruction requires immediate medical attention. In cases of volvulus or obstruction, patients are treated with IV fluids to prevent dehydration and given antibiotics to prevent infection; then surgery is performed.
K56.2 – Volvulus
Q43.3 – Congenital malformations of intestinal fixation
29980002 – Congenital malrotation of intestine
458422009 – Malrotation of intestine with midgut volvulus
- Gastric outlet obstruction
- Antral web
- Annular pancreas
- Pancreatitis (acute, chronic)
- Vascular insufficiency
- Function dyspepsia
- Gastroesophageal reflux disease
- Food poisoning (eg, bacterial, viral)
- Food protein-induced enterocolitis syndrome
- Small bowel obstructions
- Duplication cyst
- Anatomical anomalies
- Intestinal hernia