The incidence of intestinal malrotation is difficult to establish as not all affected patients develop symptoms, but autopsy studies estimate the incidence at approximately 1 in 500.
The traditional embryological basis for disorders of intestinal rotation is that of abnormal position ing of the intestinal loops in relation to one another as they return to the abdominal cavity from the yolk sac. During normal development the midgut rotates through 270° so that the duodenum lies posterior to the colon and the duodenojejunal flexure is to the left of the midline. A consistent finding in cases of malrotation is abnormal positioning of the duodenum. In 1995, an alternative hypothesis was proposed based on animal studies.18 Kluth et al proposed that malrotation is the result of failure of localized growth of the duodenal loop rather than a disorder of rotation.
The term 'malrotation' covers a spectrum of anatomical abnormalities. In non-rotation the duodenojejunal flexure lies to the right of the spine along with most of the small intestine. The cecum and colon are typically on the left side of the abdominal cavity. Adhesions formed between loops of bowel or the intestine and abdominal wall are usually responsible for obstructive symptoms at presentation. In malrotation the distribution of intestinal contents within the abdominal cavity is such that the duodenum again lies to the right of the spine with the cecum anterior to it. Adhesions between these two structures (Ladd's bands) are often present and may result in partial or total occlusion of the second part of the duodenum. In addition the mesenteric attachment to the posterior aspect of the abdominal cavity is typically very short and there is a risk of volvulus with ensuing intestinal ischemia. Other forms of abnormal intestinal rotation (inverse rotation, malrotation with mesocolic hernia and malposition of the cecum) are all rare.
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