MALROTATION OF THE INTESTINE

Malrotation of the intestinal tract is a product of a well defined abe rrant embryology. Because the consequences of malrotation associated w ith a midgut volvulus may be catastrophic, an understanding of the ana tomy, diagnostic criteria, and appropriate therapy for this putative e mergency illness is imperative. This report summarizes a recent 18-mon th experience with this diagnosis and contrasts this experience with t hat in the published literature. More than half (14/22) of the patient s presented during the first month of life, and all had vomiting, whic h in most cases was bilious. The barium upper gastrointestinal series was the preferred diagnostic study, being both sensitive (18/19, 95%) and accurate (18/21, 86%). In this series two-thirds of the patients p resented with volvulus (15/22, 68%) of whom five had ischemic intestin e requiring resection. One of these children died of overwhelming seps is. A Ladd procedure was the preferred treatment, which as defined by us includes evisceration and inspection of the mesenteric root, counte rclockwise derotation of a midgut volvulus, lysis of Ladd's bands with straightening of the duodenum along the right abdominal gutter, inver sion-ligation appendectomy, and placement of the cecum into the left l ower quadrant. A high index of suspicion in the neonate with vomiting, rapid diagnosis, and appropriate operative therapy results in a predi ctable favorable outcome for children with intestinal malrotation.