Indian Journal of Gastroenterology

, Volume 37, Issue 6, pp 545–549 | Cite as

Comparative study of intestinal malrotation in infant, children, and adult in a tertiary care center in India

  • Utpal AnandEmail author
  • Ramesh Kumar
  • Rajeev N. Priyadarshi
  • Bindey Kumar
  • Sanjay Kumar
  • Vijay Prakash Singh
Original Article



Intestinal malrotation (IM) is an uncommon condition and has varied presentation in different age groups. The study was aimed to evaluate differences in the clinical presentation, diagnosis, treatment, and outcome of IM in infants, children, and adults.


Data were collected from records of 79 patients with IM. Based on the age of presentation, these patients were categorized into three age groups: infants (up to 1 year), children (1–18 years), and adults (> 18 years). Follow up data were analyzed during 8 to 16 year after corrective surgery.


The overall age of presentation ranged from 8 days to 60 years. Twenty-eight, 29, and 22 patients belonged to the infant, children, and adult groups, respectively. The classical presentation of IM (bilious vomiting) was significantly higher in the infant compared to the children and adult groups (100% vs. 62% vs. 9.8%; p < 0.001). All infants presented with acute symptoms. However, children and adults had subacute or chronic presentations, respectively. The incidence of volvulus was significantly higher in the infant group than other two groups, (100% vs. 41% vs. 10%; p < 0.001). Doppler ultrasound was highly accurate in infants (100%), whereas contrast-enhanced computed tomography (CECT) abdomen was found to be most useful in adults. Postoperative complications were more common in adults.


Intestinal malrotation can present in patients of any age group. An increased awareness about the atypical presentations of this condition among adults may reduce the time to accurate diagnosis of this disease.


Intestinal obstruction Malrotation Volvulus 



The authors acknowledge the contribution of Dr. Alok Ranjan, Assistant Professor, Department of Community and Family Medicine, AIIMS, Patna for statistical analysis.

Compliance with ethical standards

Conflict of interest

UA, RK, RNP, BK, SK, and VPS declare that they have no conflict of interest.

Ethical clearance

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on

Informed consent

Written informed consent was obtained from all the patients for participation in this study.


The authors are solely responsible for the data and the content of the paper. In no way the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.


  1. 1.
    Millar AJ, Rode H, Cywes S. Malrotation and volvulus in infancy and childhood. Semin Pediatr Surg. 2003;12:229–36.CrossRefGoogle Scholar
  2. 2.
    Lampl B, Levin TL, Berdon WE, Cowles RA. Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol. 2009;39:359–66.CrossRefGoogle Scholar
  3. 3.
    Burke MS, Glick PL. Gastrointestinal malrotation with volvulus in an adult. Am J Surg. 2008;195:501–3.CrossRefGoogle Scholar
  4. 4.
    Fu T, Tong WD, He YJ, Wen YY, Luo DL, Liu BH. Surgical management of intestinal malrotation in adults. World J Surg. 2007;31:1797–803.CrossRefGoogle Scholar
  5. 5.
    Gong J, Zheng ZJ, Mai G, Liu XB. Malrotation causing duodenal chronic obstruction in an adult. World J Gastroenterol. 2009;15:1144–6.CrossRefGoogle Scholar
  6. 6.
    Nehra D, Goldstein AM. Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 2011;149:386–93.CrossRefGoogle Scholar
  7. 7.
    Durkin ET, Lund DP, Shaaban AF, Schurr MJ, Weber SM. Age-related differences in diagnosis and morbidity of intestinal malrotation. J Am Coll Surg. 2008;206:658–63.CrossRefGoogle Scholar
  8. 8.
    Penco JM, Murillo JC, Hernandez A, et al. Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age. Pediatr Surg Int. 2007;23:723–30.CrossRefGoogle Scholar
  9. 9.
    Ladd W. Surgical disease of the alimentary tract in infants. N Engl J Med. 1936;215:705–8.CrossRefGoogle Scholar
  10. 10.
    Nagdeve NG, Qureshi AM, Bhingare PD, Shinde SK. Malrotation beyond infancy. J Pediatr Surg. 2012;47:2026–32.CrossRefGoogle Scholar
  11. 11.
    Husberg B, Salehi K, Peters T, et al. Congenital intestinal malrotation in adolescent and adult patients: a 12-year clinical and radiological survey. Springerplus. 2016;5:245.Google Scholar
  12. 12.
    Kumar B, Kumar M, Kumar P, Sinha AK, Anand U, Kumar A. Color Doppler-an effective tool for diagnosing midgut volvulus with malrotation. Indian J Gastroenterol. 2017;36:27–31.CrossRefGoogle Scholar
  13. 13.
    Applegate KE, Anderson JA, Klatte E. Malrotation of the gastrointestinal tract: a problem solving approach to performing the upper GI series. Radiographics. 2006;26:1485–500.CrossRefGoogle Scholar
  14. 14.
    Hsu SD, Yu JC, Chou SJ, Hsieh HF, Chang TH, Liu YC. Midgut volvulus in an adult with congenital malrotation. Am J Surg. 2008;195:705–7.CrossRefGoogle Scholar
  15. 15.
    Devane SP, Coombes R, Smith VV, et al. Persistent gastrointestinal symptoms after correction of malrotation. Arch Dis Child. 1992;67:218–21.Google Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Utpal Anand
    • 1
    Email author
  • Ramesh Kumar
    • 2
  • Rajeev N. Priyadarshi
    • 3
  • Bindey Kumar
    • 4
  • Sanjay Kumar
    • 5
  • Vijay Prakash Singh
    • 6
  1. 1.Department of Surgical GastroenterologyAll India Institute of Medical SciencesPatnaIndia
  2. 2.Department of GastroenterologyAll India Institute of Medical SciencesPatnaIndia
  3. 3.Department of RadiodiagnosisAll India Institute of Medical SciencesPatnaIndia
  4. 4.Department of Pediatric SurgeryAll India Institute of Medical SciencesPatnaIndia
  5. 5.Department of Surgical GastroenterologyIndira Gandhi Institute of Medical SciencesPatnaIndia
  6. 6.Department of GastroenterologyPatna Medical College and HospitalPatnaIndia

Personalised recommendations