Attention has been focused mostly on midgut volvulus, which frequently occurs in the immediate neonatal period and is usually associated with midgut malrotation. However, there are instances such as our case where the defect is related to lack of fixation of the large bowel rather than malrotation. Pochaczevsky et al. 7 reported two cases of volvulus in older children. One of them was the result of lack of fixation of the right colon in its normal retroperitoneal position, which resulted in massive necrosis of the small bowel and the right side of the colon.
Colonic volvulus is unusual in children, and has been reported to affect the sigmoid or cecum.
Our patient had volvulus of the right and transverse colon up to the splenic flexure with necrosis, as a result of lack of fixation of the right colon. Intraoperative photograph showing massively dilated colon with volvulus. Awareness of the possibility of these rare types of malrotation in patients who, like ours, present beyond the neonatal period, may help reduce the delay in diagnosis and treatment, as well as minimize associated morbidity and mortality. References Yanez R, Spitz L. Intestinal malrotation presenting outside the neonatal period. Malrotation of the midgut in infants and children.