• Augusto Zani
  • Agostino PierroEmail author
Reference work entry


Intestinal malrotation comprises the spectrum of abnormalities of midgut development associated with abnormal rotation and/or fixation. Intestinal malrotation is characterized by the congenital abnormal positioning of the midgut, narrowing the dorsal mesenteric root and putting the bowel at risk of midgut volvulus. It is usually associated to the presence of peritoneal folds, the Ladd’s bands, which cross from the colon and cecum to the duodenum and liver and can cause duodenal obstruction.

Patients with intestinal malrotation can remain asymptomatic or may present with signs of acute bowel obstruction, such as colicky abdominal pain, abdominal distention, bilious vomiting, or shock. The surgical treatment is the Ladd’s procedure with derotation of the volvulus, division of the Ladd’s bands, widening of the small intestine’s mesentery, appendectomy, and correctional placement of the cecum and colon.


Intestinal malrotation Midgut volvulus Ladd’s bands Ladd’s procedure 


  1. Aboagye J, Goldstein SD, Salazar JH, Papandria D, Okoye MT, Al-Omar K, Stewart D, Lukish J, Abdullah F. Age at presentation of common pediatric surgical conditions: reexamining dogma. J Pediatr Surg. 2014;49(6):995–9.CrossRefGoogle Scholar
  2. Bass KD, Rothenberg SS, Chang JH. Laparoscopic Ladd’s procedure in infants with malrotation. J Pediatr Surg. 1998;33(2):279–81.CrossRefGoogle Scholar
  3. Catania VD, Lauriti G, Pierro A, Zani A. Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int. 2016;32(12):1157–64.CrossRefGoogle Scholar
  4. Cullis PS, Siminas S, Losty PD. Is screening of intestinal foregut anatomy in heterotaxy patients really necessary?: A systematic review in search of the evidence. Ann Surg. 2016;264(6):1156–61.CrossRefGoogle Scholar
  5. Daneman A. Malrotation: the balance of evidence. Pediatr Radiol. 2009;39(Suppl 2):S164–6.CrossRefGoogle Scholar
  6. Graziano K, Islam S, Dasgupta R, Lopez ME, Austin M, Chen LE, Goldin A, Downard CD, Renaud E, Abdullah F. Asymptomatic malrotation: diagnosis and surgical management: an American Pediatric Surgical Association outcomes and evidence based practice committee systematic review. J Pediatr Surg. 2015;50(10):1783–90.CrossRefGoogle Scholar
  7. Hennessey I, John R, Gent R, Goh DW. Utility of sonographic assessment of the position of the third part of the duodenum using water instillation in intestinal malrotation: a single-center retrospective audit. Pediatr Radiol. 2014;44(4):387–91.CrossRefGoogle Scholar
  8. Huntington JT, Lopez JJ, Mahida JB. Comparing laparoscopic versus open Ladd’s procedure in pediatric patients. J Pediatr Surg. 2017;52(7):1128–1131.CrossRefGoogle Scholar
  9. Khatami A, Mahdavi K, Karimi MA. Ultrasound as a feasible method for the assessment of malrotation. Pol J Radiol. 2014;19(79):112–6.Google Scholar
  10. Kiely EM, Pierro A, Pierce C, Cross K, De Coppi P. Clot dissolution: a novel treatment of midgut volvulus. Pediatrics. 2012;129(6):e1601–4.CrossRefGoogle Scholar
  11. Kluth D, Fiegel H. The embryology of the foregut. Semin Pediatr Surg. 2003;12(1):3–9.CrossRefGoogle Scholar
  12. Ladd WE. Surgical diseases of the alimentary tract in infants. N Engl J Med. 1936;215:705–8.CrossRefGoogle Scholar
  13. Lampl B, Levin TL, Berdon WE, Cowles RA. Malrotation and midgut volvulus: ahistorical review and current controversies in diagnosis and management. Pediatr Radiol. 2009;39(4):359–66.CrossRefGoogle Scholar
  14. Landisch R, Abdel-Hafeez AH, Massoumi R, Christensen M, Shillingford A, Wagner AJ. J Pediatr Surg. 2015;50(11):1971–4.CrossRefGoogle Scholar
  15. Langer JC. Intestinal rotation abnormalities and midgut volvulus. Surg Clin N Am. 2017;97(1):147–59.CrossRefGoogle Scholar
  16. Menten R, Reding R, Godding V, Dumitriu D, Clapuyt P. Sonographic assessment of the retroperitoneal position of the third portion of the duodenum: an indicator of normal intestinal rotation. Pediatr Radiol. 2012;42(8):941–5.CrossRefGoogle Scholar
  17. Millar AJ, Rode H, Cywes S. Malrotation and volvulus in infancy and childhood. Semin Pediatr Surg. 2003;12(4):229–36.CrossRefGoogle Scholar
  18. Nehra D, Goldstein AM. Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 2011;149(3):386–93.CrossRefGoogle Scholar
  19. Stanfill AB, Pearl RH, Kalvakuri K, Wallace LJ, Vegunta RK. Laparoscopic Ladd’s procedure: treatment of choice for midgut malrotation in infants and children. J Laparoendosc Adv Surg Tech A. 2010;20(4):369–72.CrossRefGoogle Scholar
  20. Tan YW, Khalil A, Kakade M, et al. Screening and treatment of intestinal rotational abnormalities in heterotaxy: a systematic review and meta-analysis. J Pediatr. 2016;171:153–62.e1–3.CrossRefGoogle Scholar
  21. Yousefzadeh DK. The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation. Pediatr Radiol. 2009;39(Suppl 2):S172–7.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Division of General and Thoracic SurgeryThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of SurgeryUniversity of TorontoTorontoCanada
  3. 3.Division of General and Thoracic Surgery, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  4. 4.Department of SurgeryUniversity of TorontoTorontoCanada

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