Intestinal malrotation

Summary of clinical findings in malrotation resulting in midgut volvulus

Features of obstruction with ischaemia (midgut volvulus with vascular compromise) include:

• Bilious vomiting

• Acutely ill patient with severe acute abdominal pain

• Abdominal tenderness

• Signs of peritoneal catastrophe (distension and guarding)

• Tachycardia

• Acidosis

• Tachypnoea

Features of obstruction without ischaemia (midgut volvulus without vascular compromise) include:

• Bilious vomiting

• Crampy abdominal pain in waves

• Non-tender abdomen

• Non-distended abdomen

• No severe physiological perturbation

Features of intermittent or partial volvulus or obstructing Ladd's bands include:

• Intermittent vomiting

• No signs of acute illness

• Intermittent abdominal pain (typically post-prandial)

• Weight loss

Features of questionable malrotation or asymptomatic/incidental finding in investigating for reflux (fussiness, arching, apnoeic events, reactive airways, pneumonia) include:

• Intermittent vomiting

• No signs of acute illness