• Augusto Zani
  • Agostino Pierro
Part of the Springer Surgery Atlas Series book series (SPRISURGERY)


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.


Intestinal malrotation Midgut volvulus Rotation anomaly Ladd’s procedure 

Suggested Reading

  1. Bass KD, Rothenberg SS, Chang JH. Laparoscopic Ladd’s procedure in infants with malrotation. J Pediatr Surg. 1998;33:279–81.CrossRefGoogle Scholar
  2. Clark LA, Oldham KT. Malrotation. In: Ashcraft KW, Murphy JP, Sharp RJ, Sigalet DL, Snyder CL, editors. Pediatric surgery. 3rd ed. Philadelphia: WB Saunders; 2002. p. 425–34.Google Scholar
  3. Kiely EM, Pierro A, Pierce C, Cross K, De Coppi P. Clot dissolution: a novel treatment of midgut volvulus. Pediatrics. 2012;129:e1601–4.CrossRefGoogle Scholar
  4. Kluth D, Fiegel H. The embryology of foregut. Semin Pediatr Surg. 2003;12:3–9.CrossRefGoogle Scholar
  5. Ladd WE. Surgical diseases of the alimentary tract in infants. N Engl J Med. 1936;215:705–8.CrossRefGoogle Scholar
  6. 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
  7. Millar AJ, Rode H, Cywes S. Malrotation and volvulus in infancy and childhood. Semin Pediatr Surg. 2003;12:229–36.CrossRefGoogle Scholar
  8. Prasil P, Flageole H, Shaw KS, Nguyen LT, Youssef S, Laberge JM. Should malrotation in children be treated differently according to age? J Pediatr Surg. 2000;35:756–8.CrossRefGoogle Scholar
  9. Spitz L. Malrotation. In: Puri P, editor. Newborn surgery. London: Arnold; 2003. p. 435–9.CrossRefGoogle Scholar
  10. 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;20:369–72.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Augusto Zani
    • 1
  • Agostino Pierro
    • 1
  1. 1.Division of General and Thoracic Surgery, Department of SurgeryThe Hospital for Sick Children, University of TorontoTorontoCanada

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