Intestinal malrotation is a congenital anomaly of rotation of the midgut. It occurs during the first trimester as the fetal gut undergoes a complex series of growth and development. Malrotation can lead to a dangerous complication called volvulus. Malrotation can refer to a spectrum of abnormal intestinal positioning, often including: The small intestine found predominantly on the right side of the abdomen The cecum displaced from its usual position in the right lower quadrant into the epigastrium or right hypochondrium An absent or displaced ligament of Treitz Fibrous peritoneal bands called bands of Ladd running across the vertical portion of the duodenum An unusually narrow, stalk-like mesentery The position of the intestines, narrow mesentery and Ladd's bands can contribute to several severe gastrointestinal conditions. The narrow mesentery predisposes some cases of malrotation to midgut volvulus, a twisting of the entire small bowel that can obstruct the mesenteric blood vessels leading to intestinal ischemia, necrosis, and death if not promptly treated. The fibrous Ladd's bands can constrict the duodenum, leading to intestinal obstruction. Signs and symptoms Signs and symptoms of malrotation vary depending on if the patient is suffering from an acute volvulus or experiencing chronic symptoms. If the patient, most often an infant, presents acutely with midgut volvulus, it is usually manifested by bilious vomiting, crampy abdominal pain, abdominal distention, and in late cases, the passage of blood and mucus in their stools. Patients with chronic, uncorrected or undiagnosed malrotation can have recurrent abdominal pain and vomiting. Malrotation may be asymptomatic. Complications Intestinal malrotation can lead to a number of disease manifestations and complications such as: Acute midgut volvulus Chronic midgut volvulus Acute duodenal obstruction Chronic duodenal obstruction Short bowel syndrome, in cases of volvulus with intestinal necrosis Death, in cases of volvulus with pan-necrosis of the bowel, severe septic shock or hypovolemic shock Malabsorption Chronic motility issues Internal herniation Superior mesenteric artery syndrome Causes The exact cause of intestinal malrotation is unknown. It is not definitively associated with a particular gene, but there is some evidence of recurrence in families. Diagnosis Malrotation is most often diagnosed during infancy, however, some cases are not discovered until later in childhood or even adulthood. With acutely ill patients, consider emergency surgery laparotomy if there is a high index of suspicion. In cases of volvulus, plain radiography may demonstrate signs of duodenal obstruction with dilatation of the proximal duodenum and stomach but it