Malrotation is a congenital abnormal positioning of the midgut. Intestinal development is traditionally described as a process of elongation, rotation, and fixation. The process begins in the fifth week of gestation. Elongation of the bowel exceeds abdominal cavity expansion and the bowel herniates from the abdomen. As the bowel returns to the abdomen, it rotates 270° anticlockwise around the superior mesenteric artery (SMA). Rotation is completed by week 10 of gestation, with the SMA contained within a broad mesenteric base attachment. The distal duodenum comes to lie across the midline towards the left upper quadrant, attached to the posterior abdominal wall by the ligament of Treitz at the duodeno-jejunal (D-J) flexure. The caecum passes to the right and downwards and becomes fixed to the posterior abdominal wall. This latter process may be incomplete at birth, giving rise to a “high” caecum, a variant of normal in the neonate.
KeywordsIntestinal malrotation Midgut volvulus Rotation anomaly Ladd’s procedure
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