Intestinal malrotation and nonrotation are well described in the pediatric literature, but presentation of nonrotation in adulthood is rare. The chronic pain associated with nonrotation is often intermittent and colicky. It often precedes diarrhea and is relieved by vomiting. The main complications of intestinal nonrotation are related to the short, unfixed root of the small-bowel mesentery. As a result, the narrow mesenteric attachment allows midgut rotation, resulting in secondary ischemia.
Abnormal anatomy leads to misdiagnosis of diseases of the appendix, cecum and colon.
Intestinal nonrotation occurs because of failure of intestinal rotation and fixation in the second stage of embryonic development. Patients with intestinal nonrotation and chronic vague symptoms can be managed nonoperatively. For those in whom nonrotation is found at laparotomy, a procedure to reduce the risk of midgut volvulus is recommended. Ladd's procedure consists of lysis of duodenal, cecocolic and small-bowel adhesions. This increases the small-bowel mesentery base.