Abstract
Normal intestinal growth and development follows a stereotypical pattern of mesenteric rotation and subsequent intestinal fixation to the body wall during fetal life. Clinically apparent abnormalities of intestinal rotation and fixation are encountered infrequently. The major life-threatening problem associated with abnormal intestinal rotation and fixation is the potential for the intestine to twist on its mesenteric axis, giving rise to a surgical condition known as midgut volvulus. Given the relatively unpredictable nature of midgut volvulus and the catastrophic consequences of subsequent total intestinal necrosis, clinicians must maintain a high index of suspicion for malrotation with volvulus in any infant or child with bilious emesis. In a symptomatic infant or child with midgut volvulus, prompt diagnosis and surgical intervention are essential for prevention of intestinal necrosis. In the incidentally diagnosed asymptomatic infant or child, many pediatric surgeons also recommend prophylactic operative intervention.
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