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The identification and treatment of intestinal malrotation in older children

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Intestinal malrotation is often diagnosed in infancy. The true incidence of malrotation outside of this age is unknown. These patients can present atypically or be asymptomatic and diagnosed incidentally. We evaluate the incidence, clinical presentation, ideal imaging, and intra-operative findings of patients with malrotation over 1 year of age.


Retrospective review was conducted in patients older than 1 year, treated for malrotation at a single pediatric tertiary care center from 2000 to 2015. Data analyzed included demographics, presentation, imaging, intraoperative findings, and follow-up. Patients predisposed to malrotation were excluded.


246 patients were diagnosed with malrotation, of which 77 patients were older than 1 year of age. The most common presenting symptoms were vomiting (68%) and abdominal pain (57%). The most common method of diagnosis was UGI (61%). In 88%, the UGI revealed malrotation. 73 of 75 were confirmed to have malrotation at surgery. Intra-operatively, 60% were found to have a malrotated intestinal orientation and 33% with a non-rotated orientation. Obstruction was present in 22% with 12% having volvulus. Of those with follow-up, 58% reported alleviation of symptoms.


Despite age malrotation should be on the differential given a variable clinical presentation. UGI should be conducted to allow for prompt diagnosis and surgical intervention.

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Authors and Affiliations



CD: review of original data, statistical analysis and interpretation, re-drafting of article, approval of article. JS: drafting article, critical revision of article, approval of article. KW: concept and design, data collection, data analysis and interpretation, critical revision of article, approval of article. SS: data collection, data analysis. KG: data collection, data analysis and interpretation, approval of article. SDP: concept and design, data analysis and interpretation, critical revision of article, approval of article.

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Correspondence to Shawn D. St. Peter.

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The authors have no conflict of interest to disclose.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was waived by our IRB due to the fact that the data collected for this study were retrospective and de-identified.

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Dekonenko, C., Sujka, J.A., Weaver, K. et al. The identification and treatment of intestinal malrotation in older children. Pediatr Surg Int 35, 665–671 (2019).

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