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Malrotation and Volvulus

Midgut volvulus (MGV) associated with malrotation most commonly presents in the first month of life but is occasionally seen in infants 1 to 6 months of age. Rarely, MGV develops later in childhood, and patients will give a history of nonspecific intermittent gastrointestinal symptoms for years. Malrotation occurs when the embryonic midgut fails to rotate either partially or completely. Between 30% and 60% of patients with malrotation have additional GI tract abnormalities. MGV can result in obstruction and bowel ischemia if unrecognized. Based on several recent series, mortality is about 5% but has generally decreased in recent years as a result of early surgical intervention.


Volvulus can be an acquired or congenital condition.

The developmental abnormality that causes volvulus in babies is known as malrotation. The central part of the intestine rotates into its final position in about the tenth week of pregnancy. Occasionally this part of the intestine does not rotate fully, leaving the bowel more liable to later twisting. Infants develop sudden onset signs of bowel obstruction that may such as includes:

  • Nausea and vomiting
  • Bloody stools
  • Abdominal pain
  • Constipation
  • Shock.

In babies with malrotation with volvulus, the vomit will be green in color. Symptoms are generally dramatic enough that infants are taken early to the emergency room, which can be critical for survival.

Volvulus that occurs later in life is most likely due to problems that have arisen either from an infection or from surgery.


  • Bilious (green) vomiting ++++; most common in patients less than 1 month old. Nonbilious vomiting and irritability and pain are less common.
  • Intermittent vomiting
  • Poor feeding
  • Abdominal bloating


  • Abdominal distention may or may not be present, since obstruction may be proximal.
  • Bowel sounds, whether present or absent, are neither sensitive nor specific for malrotation and volvulus.
  • Blood in the stool (gross or occult) ++ is an ominous sign that may signal bowel ischemia.


Specific treatment for malrotation and volvulus will be determined by your child's physician based on the following, the extent of the problem, your child's age, overall health, medical history, the opinion of the surgeon and other physicians involved in your child's care, expectations for the course of the problem, your opinion and preference.


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