is often non-specific. Ultrasonography may be useful in some cases of volvulus, depicting a "whirlpool sign" where the superior mesenteric artery and superior mesenteric vein have twisted. Upper gastrointestinal series is the modality of choice for the evaluation of malrotation, as it will often show an abnormal position of the duodenum and duodeno-jejunal flexure (ligament of Treitz). In cases of malrotation complicated with volvulus, upper GI demonstrates a corkscrew appearance of the distal duodenum and jejunum. In cases of obstructing Ladd's bands, upper GI may reveal a duodenal obstruction. Although upper GI series is regarded as the most reliable diagnostic test for intestinal malrotation, false negatives may occur in 5% of cases. False negatives are most frequently attributed to radiographer error, uncooperative pediatric patients, or variations in intestinal positioning. In equivocal cases physicians may wish to repeat the upper GI or consider additional diagnostic modalities. Lower gastrointestinal series, may be helpful in some patients by showing the caecum at an abnormal location. CT scan and magnetic resonance imaging may also aide in the diagnosis of equivocal cases. The incidence of intestinal malrotation in infants with omphalocoele is low. Therefore, there is little evidence to support the screening for intestinal malrotation in infants with omphalocoele. Treatment Prompt surgical treatment is necessary for intestinal malrotation when volvulus has occurred: First, the patient is resuscitated with fluids to stabilize them for surgery The volvulus is corrected (counterclockwise rotation of the bowel), The fibrous Ladd's bands over the duodenum are cut, The mesenteric pedicle is widened by separation of the duodenum and cecum, The small and large bowels are placed in a position that reduces their risk of future volvulus With this condition the appendix is often on the wrong side of the body and therefore removed as a precautionary measure during the surgical procedure. This surgical technique is known as the "Ladd's procedure", after Dr. William Ladd. Long-term research on the Ladd's procedure indicates that even after surgery, some patients are susceptible to GI issues and may need further surgery. See also Situs inversus, a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. References External links Congenital disorders of digestive system