This places the ileocecal junction in the right lower quadrant of the peritoneal cavity. In malrotation, the site of obstruction is usually the second or third portions of the duodenum. Although duodenal obstruction is a common presentation of malrotation, midgut volvulus with intestinal gangrene is the most feared complication of intestinal obstruction. To obviate this, Powell et al. 6 questioned labelling patients as asymptomic or incidental malrotation, and recommended prompt elective Ladd's procedure in all patients found to have abnormalities of malrotation and fixation. Malrotation is easily diagnosed when it presents in the neonatal period.
Bilious vomiting is the most frequent symptom in the first month of life.
1 Malrotation presenting beyond the neonatal period is associated with a multiplicity of symptoms which are often nonspecific. These include diarrhea, constipation, failure to thrive, malabsorption and protein deficiency. Although the most common site of obstruction in malrotation is at the second or third portion of the duodenum, there are reports of unusual types of malrotation. In the Spigland et al. 5 series of 82 patients, six unusual types of malrotation were documented. Of these, four had right paramesocolic hernia, one had malrotation of the duodenum of the small bowel without malrotation of the colon, and the other had reversed rotation with the colon passing beyond the superior mesenteric artery and duodenum.