Rationale and technic for stabilization of the mesentery in cases of nonrotation of the midgut

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1. 1. Nonrotation of the midgut is potentially the most dangerous of the various degrees of malrotation because it predisposes the midgut volvulus. 2. 2. The characteristic anatomical feature of these cases is that of a pedicle consisting of the third part of the duodenum, the proximal jejunum, and the ascending colon, overlying and parallel to the superior mesenteric vessels and surrounded by a peritoneal covering. This pedicle constitutes the only attachment of the midgut within the abdomen, thus allowing volvulus. There are other less common anatomical variants of this entity. 3. 3. Nonrotation of the midgut may be found without other anomalies. In addition, it is found in most cases of omphalocele and gastroschisis and also in congenital hernia of the posterolateral diaphragm. 4. 4. Using the conventional operative management for these infants, there were three instances of recurrence of volvulus among 24 cases treated without stabilization. There was one instance of volvulus after diaphragmatic hernia repair in which the nonrotation was not stabilized. 5. 5. When midgut volvulus is encountered, it should be untwisted. After this is done, or when nonrotation of the midgut is found without volvulus, the components of the pedicle of the midgut should be freed by anterior division of the peritoneal bands. Blunt dissection of the duodenum from the proximal transverse colon, fixation of the cecum and its mesentery to the left colon, and suture of the duodenum to the right completes the procedure. 6. 6. A series of 10 operative cases is described.