MALROTATION OF THE BOWEL

An interruption of the embryologic events of intestinal rotation of fixation gives rise to the various types of malrotation.  With improper rotation, fixation of the intestine within the peritoneal cavity is abnormal.  The base of the small bowel mesentery is extremely narrow and prone to twisting.  In addition, the fibrotic reaction that would normally fix the bowel to the retroperitoneum may form dense obstructing bands between the cecum and the liver across the duodenum.

 

These bands may result in partial or complete obstruction of the duodenum.  Abnormal fixation can also lead to the formation if internal hernias which can also result in intestinal obstruction.

 

Clinical Presentation-Acute Midgut Volvulus-Bilious vomiting associated with abdominal distention, pain and passage of  blood in the stool are the classic findings of midgut volvulus.  As ischemia progresses, shock and sepsis rapidly develop.

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