Bowel Rotation Research Articles

Peculiarities of the Clinical Picture of Hirschsprung’s Disease in Children of the First Year of Life Taking Into Account the Extent of Aganglionosis

The aim of the work. To investigate the peculiarities of the clinical course of Hirschsprung’s disease in children of the first year of life and to determine the significance of symptoms in the verification of the disease.
 Research materials and methods. Since 1980 up to 2021, at the pediatric surgery clinic of the National Medical University named after O.O. Bohomolets on the basis of the National Children’s Specialized Hospital “OKHMATDYT” and in the pediatric surgery clinic of the Ivano-Frankivsk National Medical University on the basis of the Ivano-Frankivsk Regional Children’s Clinical Hospital, there were examined and treated 483 children of the first year of life suffering from Hirschsprung’s disease.
 Results of the study. The clinical manifestation and course of aganglionosis varied in length at the time of hospitalization and depended on the time after birth. During the first month of life, 97 (20.08%) patients were hospitalized; of them 39 (8.07%) patients had an atypical clinical picture due to: colonic atresia in 15 (3.10%), colonic atresia + gastroschisis in 3 ( 0.62%), ileal atresia in 9 (1.86%), esophageal atresia in 3 (0.62%), cleft of the hard and soft palate in 9 (1.86%) patients. Depending on the age, there were 280 (57.97%) patients under 6 months, and 203 (42.03%) patients between 6 months and 1 year. The classic typical clinical picture was in 444 (91.93%) patients, which was characterized by the absence of meconium excretion, abdominal distension in 444 (91.93%) patients, delayed physiological weight gain against the background of nutritional insufficiency with the development of hypotrophy in 327 (67.70%) patients, vomiting of stagnant gastric and intestinal contents in 417 (86.34%) patients. On the other hand, there occurred enterocolitis in 315 (65.22%) patients, toxic megacolon in 16 (3.31%) patients, and anemia of various degrees in 241 (49.89%) patients, among the complications that arose during the examination of patients with Hirschsprung’s disease. According to the results of a comprehensive examination, the following extent of aganglionosis was determined: rectal form in 100 (20.70%) patients, rectosigmoid form – in 192 (39.75%), subtotal – in 150 (31.06%) and total in 41 (8.49%) patients. Concomitant malformations were found in 98 (20.29%) patients: renal malformations were diagnosed in 7 (1.45%) patients, concomitant heart malformations in 18 (3.73%) patients. Associated intraoperative findings were: Meckel’s diverticulum in 5 (1.03%) patients, and congenital cyst of the right ovary in 1 (0.21%) patient. The clinical course was affected by the concomitant malformations: incomplete bowel rotation in 10 (2.07%) patients and internal abdominal hernia in 2 (0.42%) patients.
 Conclusions. Clinical manifestations and course of HD primarily depend on the presence of accompanying developmental defects, which may prevail during the examination due to vital disorders. In the clinical course of Hirschsprung’s disease, it is necessary to distinguish between typical and atypical forms. Typical clinical symptoms were in 444 (91.93%), and atypical in 39 (8.07%) patients.

Intestinal malrotation: case description and publication analysis

Intestinal malrotation is a rare congenital anatomical anomaly that results from an abnormal bowel rotation at 10–12 weeks of embryonic development. Clinical manifestations depend on age. In children, intestinal malrotation is manifested by a midgut volvulus (Ladd syndrome). In adults, the presence of intestinal malrotation increases the risk of acute intestinal obstruction. This article presents a case of asymptomatic intestinal malrotation in a 52-year-old female patient.

Impact of bowel rotation and fixation on obstructive complications in congenital diaphragmatic hernia

Aim of the studySmall bowel obstruction (SBO) is a known complication after congenital diaphragmatic hernia (CDH) repair, which can require surgery and even extensive bowel resection causing short bowel syndrome (SBS). We investigate whether specific bowel rotation and fixation can be used as a predictor for SBO including volvulus. MethodsA retrospective review of 256 CDH survivors following repair from 2003 to 2020 was performed. Operative notes and upper gastrointestinal series (UGI) were screened to determine the rotation and fixation of the bowel. Primary outcomes included SBO occurrence, SBO treated surgically, and volvulus. For statistical analysis Fisher's exact test was utilized. ResultsTwenty-two (9%) patients presented with SBO and majority, 19 (86%), required surgery. Adhesion were observed in 10 (45%), recurrence in 5 (23%), and extensive volvulus leading to SBS in 3 (14%). Both rotation and fixation were recorded in 117 (46%). Presence of left CDH with malrotation and nonfixation was a significant predictor for SBO requiring surgery (P<0.05 vs all other groups). All 3 patients with extensive volvulus had left CDH with nonfixed bowel (100%), however only 1 had malrotation (33%). ConclusionsMalrotation and nonfixation are associated with increased SBO in CDH. Normal rotation is not protective and patients are still at risk for volvulus resulting in SBS. SBO requiring surgical intervention is common in CDH. Bowel rotation and fixation are important determinants that, should be routinely documented and education about the risk of SBO should be included in family counseling. Level of EvidenceLevel IV – Case Series

421P Ghost stoma – solving the dilemma of diversion after anterior resection: A single centre experience from India

Anastomotic leak is one of the most dreaded complication after anterior resection(AR) with leak rates ranging from 3 - 20 %. To avoid such leaks, many surgeons routinely perform diversion stoma after AR. However, stomas are associated with their own set of complications leading to decreased quality of life. Thus, to do prophylactic stoma or not is a matter of constant dilemma that most surgeons face. Ghost Stoma is a technique where in unnecessary prophylactic stoma can be avoided while ensuring that a diversion stoma can be created if need arises without the need of general anaesthesia. Surgical Technique: Ghost Stoma techniques done by pulling a loop of intestine up to parietal peritoneal layer of anterior abdominal wall with the help of silicone/ plastic tube at the time of anterior resection. If an anastomotic leak is detected in postoperative period, same loop of bowel can be pulled out and fashioned into stoma under local anaesthesia. Study Design: A retrospective analysis of all the cases who underwent this procedure between January 2015 to December 2019 was done. Total 68 patients underwent AR with ghost stoma at our institute during specified time period. Total 7 patients required creation of functional stoma post-operatively for suspected or confirmed leak and was done under local anesthesia in all patients. One patient had congestion of stoma due to rotation of mesentery and required refashioning of stoma under regional anesthesia. Rest of the patients had the plastic tube removed at around 2 weeks. However, none of the patients required re-laparotomy or peritoneal wash under general anaesthesia. None of the patients had any complication due to plastic tube like bowel rotation, obstruction, strangulation, adhesion, stricture or tube migration. Ghost Stoma is a very simple & safe procedure which can decrease the need of prophylactic diversion stoma in most cases of AR. It is technically easy, oncologically safe, decreases intraoperative time & also prevents patient from morbidity as well as psychological and financial burden of stoma. Using this technique unnecessary stoma could be avoided in >80 % patients of AR in this series.

TH7.5 De Garengeot hernia: a combination of niche presentation, diagnostic, and anatomical factors

Abstract Background De Garengeot hernias occur in almost 1% of femoral hernias and are diagnosed when the appendix is also present within. They are more commonly observed in post-menopausal women, but their pathogenesis remains controversial. Theories involve abnormalities in bowel rotation during embryological growth, caecum mobility or size, and increased abdominal pressure. Most are diagnosed intra-operatively and are otherwise incidentally discovered on imaging. An advised surgical technique has not been determined due to its rarity; however, most literature suggests laparoscopic hernioplasty and appendicectomy in absence of infection. Case report A 77-year-old female presented with a three-day history of a painless, right groin mass. Blood results were within normal range, and sonography identified a De Garengeot hernia suggesting appendiceal inflammation. She underwent emergency laparoscopic surgery that discovered a strangulated appendiceal tip within an incarcerated femoral hernia, which then unexpectedly divided during manipulation. Additional findings included a broad mesoappendix and lack of appendicitis. The team proceeded with a hernioplasty and appendicectomy, and the patient was discharged two days later without complications. Conclusion This case report highlights a few niche aspects of De Garengeot hernias. Firstly, it is unusual our patient's diagnosis occurred preoperatively via ultrasound; secondly, the ischaemic tip of the appendix unexpectedly self-detached upon mobilisation; and thirdly, the widened mesoappendix likely contributed towards her predisposition to De Garengeot hernias. Overall, our case represents laparoscopic surgery being optimal in treating De Garengeot hernias that are diagnosed preoperatively, and that they should remain a differential diagnosis for non-specific groin lumps, regardless of pain.

Pancreaticobiliary maljunction and pancreas divisum accompanied with intestinal malrotation: a case report

BackgroundPancreaticobiliary maljunction is a congenital anatomical abnorma l junction of the pancreatic duct and bile duct into a common channel outside the duodenal wall. Pancreas divisum is also a congenital anatomical abnormality characterized by unfused pancreatic ducts. Intestinal malrotation is caused by the failure of bowel rotation and fixation. We reported an optimal surgical intervention for the rare case of pancreaticobiliary maljunction and pancreas divisum accompanied intestinal malrotation.Case presentationA 2-year-old female presented with fever and jaundice. Abdominal ultrasound showed dilated common bile duct and intrahepatic bile ducts; MRCP showed pancreaticobiliary maljunction, pancreas divisum, and dilated biliary system; Abdominal contrast-enhanced CT showed a reversed relationship between the superior mesenteric artery and the superior mesenteric vein. An operation of laparoscopic resection of the extrahepatic bile duct, Roux-en-Y hepaticojejunostomy, and Ladd’s procedure was performed after the inflammation of the biliary system was treated. The post-operative follow-up period was uneventful.ConclusionsThe management of pancreas divisum can be conservative. We present an optimal pattern of Roux-en-Y hepaticojejunostomy to deal with pancreaticobiliary maljunction associated with intestinal malrotation.

Recurrent Choking in a 40 days Old Infant: A Diagnostic Challenge

Malrotation of the gut is a surgical problem. Clinical presentation is asymptomatic to symptomatic likes vomiting, abdominal distension, constipation, or sub-acute or acute intestinal obstruction. Rotational anomalies occur due to the arrest of normal rotation of the embryonic gut. Intestinal malrotation occurs when the normal embryological process of bowel rotation happens incorrectly or incompletely. Malrotation of gut was diagnosed by clinical features plus contrast radiograph and/or laparotomy. Our patient 40 days old infant presented with recurrent choking attack after breastfeeding with fever, cough, and respiratory distress. Infant was treated a case of aspiration pneumonia with gastroesophageal reflux, with keeping in mind trachea esophageal fistula and achalasia cardia like rare entity after exclusion of common etiology of choking. Pneumonia improved by treatment but choking persisted. Finally it was diagnosed as a case of partial malrotation of upper gut per-operatively.&#x0D; BANGLADESH J CHILD HEALTH 2021; VOL 45 (1) : 51-54

A Rare Case Report of Waugh Syndrome in an Eight Months Old Male

The author reports a case of Waugh syndrome in an 8-monthold baby boy. Although Waugh's Syndrome is rare, most of thedocumented cases are in children. Waugh syndrome, first described in 1991 by Georges Waugh, is an intussusception associated with abnormal bowel rotation (Behera, C. R., &amp; Mohanty, S. K. 2014; &amp; Henderson, A. A. et al., 2013). Less than 100 cases have been described so far worldwide. Intussusception is one of the most common causes of bowel obstruction in pediatrics. Although this intussusception is idiopathic in 81% of cases, it can sometimes be secondary to various etiologies such as Meckel's diverticulum, congenital bridles, gastroenteritis, polyposis and intestinal lymphomas. The authors discuss treatment options and discussthe probability of Waugh's Syndrome during any intussusception in children (Behera, C. R., &amp; Mohanty, S. K. 2014).

СОЧЕТАНИЕ СИНДРОМА ЛЕДДА C ВРОЖДЕННЫМ ГИПЕРТРОФИЧЕСКИМ ПИЛОРОСТЕНОЗОМ

Background. The combination of the two congenital pathological conditions – compression of the duodenum by embryonic cords of the peritoneum and congenital inversion of the small intestine and right half of the colon due to incomplete bowel rotation – was described in detail by W. E. Ladd in 1932, thus the pathology is known as “Ladd’s syndrome” (LS). Congenital pyloric stenosis belongs to a group of severe birth defects. The disease is based on a congenital violation of the morphological structures of the pyloric sphincter of the stomach due to hypertrophy of the circular muscle layer and interstitial tissue leading to pyloric stenosis and impaired patency in this part of the gastrointestinal tract. Objective. Demonstration of diagnostics and treatment peculiarities of a rare case of a combined pathology of the gastrointestinal tract in a newborn. Material and methods. The data from clinical observation of the patient M., 3 days old, who was treated in the neonatal Department of the Grodno regional children’s clinical hospital (GODKB) since December 2018 till March 2019. Results. The child was found to have a combination of Ladd’s syndrome with congenital hypertrophic pyloric stenosis. Successful correction of the birth defects was performed. Conclusion. We have presented a case report that hasn’t been yet described in literature. Despite the diffculties in diagnostics, the patient was discharged with recovery. The follow-up examination in 2020 revealed no abnormalities in the child’s development.

Imaging features of adult duodenal webbed with poor small bowel rotation:a case report

搜集经手术病理证实的成人十二指肠蹼伴小肠旋转不良患者一例。男，44岁，以反复上腹痛为主诉就诊。患者行腹部CT检查，可见十二指肠降部明显扩张，肠腔内有5 cm×3 cm充满水样密度的囊状病灶，囊壁内层见黏膜样强化，壁外还可见强化肠壁，呈双腔征改变。腹部MRI示十二指肠降部内囊状病灶T2WI呈混杂高信号，可见分层样改变。MR胰胆管成像显示十二指肠降部囊性病灶与胰胆管结构，胰管轻度扩张。术前影像诊断为十二指肠降部蹼伴小肠旋转不良。此病影像表现具有一定特征性。

Identifying intestinal malrotation on magnetic resonance examinations ordered for unrelated indications.

Anatomical imaging findings indicating normal bowel rotation can be identified on cross-sectional imaging, including magnetic resonance imaging (MRI) performed for non-related indications. The goal of our study was to assess whether non-targeted MRI can accurately assess intestinal malrotation. Four anatomical landmarks were assessed on MRIs of the chest, spine or abdomen performed from January 2006 to June 2014, on patients who also had upper gastrointestinal series (UGI) performed within 10 years of the MRI date: 1) retroperitoneal duodenum, 2) left upper quadrant duodenojejunal junction, 3) superior mesenteric artery to the left of the superior mesenteric vein, and 4) right lower quadrant cecum. Two attending radiologists, one pediatric and one abdominal radiologist, independently reviewed the MR images. The pediatric radiologist reviewed images from UGI (considered the gold standard) to determine the intestinal rotation for each case. Validation of the criteria was performed on new patients imaged through January 2016. The original cohort included 109 MRIs (15 chest, 41 spine and 53 abdomen) done on 109 patients (42% males, mean age: 10.2 years). If each of the 4 anatomical questions were answered "yes" (4-YES), specificity was 100% for each radiologist and malrotation was appropriately excluded. Using the 4-YES criteria, the pediatric radiologist excluded malrotation in 71 patients (65%) and the abdominal radiologist excluded it in 65 (60%), with concurrence for 57 patients. Validation of the 4-YES criteria in 23 new patients appropriately proved the 4-YES rule, with neither labeling the one new malrotation case 4-YES. If a radiologist can confidently answer "yes" to the four questions evaluated in this study, then intestinal rotation can be safely considered normal. Normal bowel rotation should be commented upon in MRI reports when these four anatomical locations are imaged, thus helping patients avoid unnecessary UGI and radiation exposure.

De Garengeot's Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia.

We present two cases of incarcerated de Garengeot's hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT). Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot's hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot's hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future.

Heterotaxy and intestinal rotation anomalies: 20 years experience at a UK regional paediatric surgery centre.

The association of heterotaxy with intestinal rotation anomalies is well described. However debate exists with regard optimal management notably should 'asymptomatic' bowel rotation anomalies undergo operation? The present study therefore sought to determine: (1) the risk(s) of volvulus in patients diagnosed with heterotaxy and (2) define morbidity associated with operation for 'asymptomatic' anomalies in a fragile patient cohort with co-existent congenital heart disease. Medical case record reviews of ALL heterotaxy patients born during January 1993-December 2013 and attending a UK paediatric centre were analyzed. Of a total of 92 patients, 16 (17.4%) cases underwent foregut imaging studies. Three examinations were performed in 'symptomatic' patients. Twelve studies reported 'abnormal anatomy' with only five patients undergoing surgical correction. No complication(s) were recorded after Ladd's operation to correct defects. A single fatality occurred within 30 days postoperatively from cardiac failure. In 87 patients in whom Ladd's operation was not undertaken, no single patient developed intestinal volvulus (median length of follow-up 27.2 months, total 446.1 person years). This study strongly supports a 'watchful waiting' policy for heterotaxy patients. Many children who ultimately die from heart disease may avoid unnecessary abdominal surgery.

Heterotaxy syndromes and abnormal bowel rotation

Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates.

Giant ileal duplication cyst presenting as malrotation

IntroductionAlimentary Tract Duplications (ATDs) are rare anomalies. The ileum is the most common site. Completely isolated ileal duplication cysts (IDCs) are a small subgroup of IDCs that do not communication with the gastrointestinal tract. These cysts may manifest in a variety of ways. Presentation of caseWe discuss a six-day-old female infant who presented with clinical and radiologic features of malrotation. At the time of laparotomy the bowel rotation was found to be normal, however an isolated IDC was found and resected. DiscussionIleal duplication cysts often present with bowel obstruction. In rare cases these can present with features of malrotation on upper gastrointestinal contrast series, thus detracting from the real pathology. ConclusionWe identify a rare case of completely isolated IDC presenting as malrotation in a six-day-old female infant, which was promptly recognized and surgically managed. We suspect that the weight of the duplication cyst displaced the bowel inferiorly and thus gave the radiographic appearance of malrotated bowel.

Midgut Volvulus in a 70-year-old Man Due to Intestinal Nonrotation

Intestinal malrotation is a congenital disorder that results from the failure of normal bowel rotation and fixation during the 5th gestational week. The incidence of intestinal malrotation is <0.2%, but prompt diagnosis is important because this anomaly can cause midgut volvulus and lead to fatalities. Compared to infants presenting with acute symptoms, such as abdominal pain, vomiting, or diarrhea, adult patients complain of intermittent self-limited abdominal pain. We present a case of intestinal malrotation complicated by midgut volvulus improved with conservative care in a 70-year-old man. The diagnosis was suggested on the basis of imaging findings.

Duodenum between the aorta and the SMA does not exclude malrotation

Sir, Malrotation, if not diagnosed promptly, can lead to disastrous consequences. Upper gastrointestinal fluoroscopy (UGI) has been considered for many years to be the radiologic standard for the diagnosis of malrotation [1, 2]. Therefore, any suggested change in this standard should be based on solid evidence. US has been proposed as an alternative to UGI [3]. In a paper published recently in this journal, Menten et al. [4] prospectively evaluated patients with suspected malrotation with both US and UGI and concluded that US should be used as the primary imaging modality. Unfortunately, the evidence they presented does not support this conclusion; thus, the title discussion section and conclusions are dangerously misleading. The problems with this study are legion. The number of children eventually diagnosed with malrotation (n06) is too low to have enough statistical power to draw any solid conclusions. US was compared to UGI without any gold standard. US diagnosed malrotation in only three (50%) children with obvious malrotation based on medical history: post Ladd surgery for malrotation, post repair of gastroschisis and omphalocele. They share the same type of rotational abnormality—“non-rotation” [1, 2] (Fig. 1). A study by Taylor [5] on the anatomy of the duodenum in 38 children who had surgery for malrotation showed that the duodenum was not behind the superior mesenteric artery (SMA) at surgery [5]. This is also the most common type of abnormal bowel rotation found incidentally in adults [6] and has low risk for midgut volvulus [2].

Intestinal Volvolus After Robotic Pancreaticoduodenectomy

Context Intestinal volvulus is an uncommon complication either of open surgery either of mini-invasive surgery. Recent papers report few cases of small bowel obstruction after robotic-assisted surgery, but none due to an intestinal volvulus. In our experience including more than 90 robotic pancreatic resections we have had only one intestinal volvulus. We report the case of a small bowel obstruction because of a volvulus after robotic pancreatico­duodenectomy. Case report A 42-year-old man underwent robot-assisted pancreaticoduodenectomy on July 2011 for choledochus’ adenocarcinoma. On September 2011 he was readmitted to us for an intestinal obstruction. Preoperative imaging included abdomen radiography and computed tomography. The latter showed a twisted small bowel loop with a strong lumen reduction. Robot-assisted pancreatico­duodenectomy was the only previous operation he had had. The patient underwent to a laparotomy, in order to easily diagnose the site of the obstruction. The entire small bowel was found to have rotated clockwise around the mesenteric vessels. Distal ileum, that included the obstruction, was resected. Final pathology disclosed only inflammation and granulation tissue. The postoperative course was uneventful and the patient was discharged on the fifteenth postoperative day. Conclusion The causes of small bowel rotation are not well known. An abnormally mobile bowel or other anatomic predispositions might have a role; another possible causes are post-operative adhesions that may create an axis around which the small bowel can rotate. Our patient have had only pancreaticoduodenectomy that, even if performed robotically, it is a very hard operation but at the repeat surgery the entire small bowel was found to have rotated clockwise around the mesenteric vessels without any adhesion. Robotic surgery needs the pneumoperitoneum induction and tilting table to a suitable position which are possible causes allowing a volvulus creation. In our experience, the posterior repair of peritoneum can avoid the onset of a volvulus and it can be as easily performed by robotic approach as in open surgery.

CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation

CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation

The Incidence of Symptomatic Malrotation Post Gastroschisis Repair

Gastroschisis is known to be associated with abnormal bowel rotation. Currently, the broadly accepted practice is not to perform Ladd's procedure routinely at the time of closure of gastroschisis defects. However the incidence of symptomatic malrotation and volvulus post gastroschisis repair is unknown; this incidence is important in view of the current practice of bedside gastroschisis closure. This study examined the incidence of symptomatic malrotation and volvulus following gastroschisis repair. Patients who had undergone gastroschisis repair between 1999 and 2009 in any of 2 tertiary centers were identified using the Hospital Inpatient Enquiry system. The medical records were reviewed to obtain demographic data and postoperative outcomes. Patients were contacted for follow-up. 128 patients were identified with a median postoperative follow-up of 4 years (range: 6 weeks to 12 years). Upper gastrointestinal (GI) contrast studies were performed in 30 patients (23.4%), 21 (16.4%) of whom showed evidence of malrotation. Malrotation was documented during the primary repair in 12 patients (9.4%); however Ladd's procedure was performed primarily in only 3 patients. 7 patients underwent Ladd's procedure in a second laparotomy for mechanical obstruction secondary to causes not related to malrotation and volvulus. A total of 29 patients (22.7%) had either operative or radiological evidence of malrotation. None of these patients developed volvulus after being followed for a median period of 4 years. Bedside gastroschisis closure without concomitant Ladd's procedure is a safe practice. None of the patients with documented malrotation developed volvulus post gastroschisis repair.