Management and Diagnosis of Intestinal Malrotation

Intestinal malrotation is a spectrum of congenital anomalies arising from abnormal rotation and fixation of the midgut during embryogenesis, with presentations ranging from acute neonatal volvulus to chronic intermittent abdominal pain in adults. Prompt recognition relies on a high index of suspicion, particularly where clinical features such as bilious vomiting, abdominal pain or signs of obstruction arise. Diagnostic strategies encompass contrast fluoroscopy, ultrasonography and, increasingly, computed tomography to delineate anatomical relationships of the duodenum and mesenteric vessels. Management is uniformly surgical, with the Ladd’s procedure representing the cornerstone of intervention. Minimally invasive techniques have emerged, offering shorter recovery and reduced wound complications. Long-term follow-up addresses persistent gastrointestinal symptoms and guides nutritional and developmental support. Multidisciplinary care, informed by advancing imaging modalities and patient-centred data, underpins improved outcomes and informs evolving guidelines worldwide.

Research from Nature Portfolio

Recent 3D imaging of embryonic gut development using microcomputed tomography has provided unprecedented visualisation of midgut loop formation, physiological herniation and rotational dynamics. These studies refine the classical model of intestinal rotation by detailing spatial relationships within the umbilical coelom and subsequent return to the abdominal cavity. Enhanced understanding of normal morphogenesis offers a foundation for identifying mechanical or molecular disruptions that may underlie congenital malrotation and related disorders, and may guide future work on early detection and targeted interventions.

Management and Diagnosis of Intestinal Malrotation publication trend

The graph below shows the total number of articles in management and diagnosis of intestinal malrotation across all publications each year (not limited to Nature Index journals).

Technical terms

Intestinal malrotation: Congenital failure of the midgut to complete its normal 270° rotation and fixation.

Midgut volvulus: Twisting of the small intestine around the superior mesenteric vessels, risking ischaemia and necrosis.

Ladd’s procedure: Surgical correction involving division of Ladd’s bands, widening of the mesenteric base and appendicectomy.

Duodenal–jejunal junction (DJJ): Anatomical landmark marking the transition between the second part of the duodenum and proximal jejunum.

Retromesenteric duodenum sign: Radiological observation of the duodenal horizontal segment lying anterior to the superior mesenteric artery.

Patient-generated registry: Data collection platform where individuals self-report symptoms, treatments and outcomes over time.

References

1. Diagnosis of adult midgut malrotation in CT: sign of absent retromesenteric duodenum reliable. Insights into Imaging (2025).
2. IMPOWER: a national patient-generated registry for intestinal malrotation exploring diagnosis, treatment, and surgical outcomes. Orphanet Journal of Rare Diseases (2023).
3. Midgut development in rat embryos using microcomputed tomography. Communications Biology (2021).
4. Laparoscopic vs open Ladd’s procedure for malrotation in neonates and infants: a propensity score matching analysis. BMC Surgery (2022).