RT Book, Section
A1 Shah, Ashish
A1 Sobolewski, Brad
A1 Mittiga, Matthew R.
A2 Knoop, Kevin J.
A2 Stack, Lawrence B.
A2 Storrow, Alan B.
A2 Thurman, R. Jason
SR Print(0)
ID 1181044314
T1 Intestinal Malrotation with Volvulus
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessmedicine.mhmedical.com/content.aspx?aid=1181044314
RD 2024/04/19
AB Intestinal  malrotation  with  volvulus  is  primarily  a  condition  of  infancy  but  can  be  seen  in  older  children  and  adults.  During  week  4  of  embryonic  development,  the  primary  intestinal  loop  bulges  into  the  yolk  sac  and  rotates  270  degrees  counterclockwise.  Between  weeks  8  and  10,  it  returns  to  the  enlarged  abdominal  cavity  and  is  fixed  via  mesentery  that  extends  from  the  ligament  of  Treitz  to  the  ileocecal  valve  in  the  right  lower  quadrant.  In  malrotation,  the  duodenum,  jejunum,  and  cecum  are  partially  rotated  with  the  bowel  anchored  by  an  abnormally  thin  band  of  mesentery.  The  bowel  can  twist  on  this  thin  mesentery,  which  contains  the  superior  mesenteric  artery,  leading  to  acute  intestinal  obstruction  and  midgut  vascular  compromise  known  as  volvulus.  Also,  the  abnormally  positioned  cecum  now  rests  in  the  upper  abdomen  fixed  to  the  right  lateral  abdominal  wall  by  bands  of  peritoneum  (Ladd  bands)  that  cross  and  can  obstruct  the  duodenum.