Midgut volvulus and intestinal malrotation

Last updated: February 6, 2023

Summarytoggle arrow icon

Volvulus is defined as the twisting of a loop of bowel on its mesentery and is one of the most common causes of intestinal obstruction. Volvulus in a neonate or infant almost always presents as a midgut volvulus secondary to intestinal malrotation. Patients typically show features of bowel obstruction (abdominal pain, distension, bilious vomiting) or of bowel ischemia and gangrene (tachycardia, hypotension, hematochezia, peritonitis) in severe cases. Upper GI series is the investigation of choice in infants with suspected midgut volvulus, which is seen as a cork-screw duodenum. The Ladd procedure (laparotomy and detorsion of the volvulus) is indicated in all patients with intestinal malrotation since it is impossible to predict if volvulus of the midgut will occur in an asymptomatic patient or not.

See “Sigmoid volvulus and cecal volvulus” for more details of volvulus occurring in adults.

Epidemiologytoggle arrow icon

SigmOid volvulus is more common in Older individuals while Midgut volvulus and Malrotation are more common in Minors.

Epidemiological data refers to the US, unless otherwise specified.

Pathophysiologytoggle arrow icon

Common types of intestinal malrotation [3][4][5]
Nonrotation Incomplete rotation
  • The mesenteric attachment has a wider base than in incomplete rotation

Risk factorstoggle arrow icon

Clinical featurestoggle arrow icon

Diagnosticstoggle arrow icon

Intestinal malrotation and midgut volvulus

Imaging in intestinal malrotation and midgut volvulus

Intestinal malrotation

Midgut volvulus

Upper GI series (gold standard in hemodynamically stable patients) [5][10]

  • Displaced duodenojejunal junction
  • The small bowel is right-sided.
  • Duodenal obstruction
  • Corkscrew duodenum
Barium enema (lower GI series)
Abdominal ultrasound [11]

CECT scan (oral and IV contrast)

Abdominal x-ray


Differential diagnosestoggle arrow icon


The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Referencestoggle arrow icon

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  2. Buchmiller T. Intestinal malrotation in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: February 2, 2016. Accessed: March 28, 2017.
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  4. Malrotation. Updated: March 28, 2017. Accessed: March 28, 2017.
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  13. Yigit M, Turkdogan KA. Coffee bean sign, whirl sign and bird's beak sign in the diagnosis of sigmoid volvulus. Pan Afr Med J. 2014; 19: p.56.doi: 10.11604/pamj.2014.19.56.5142 . | Open in Read by QxMD
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  16. Jaffe T, Thompson WM. Large-Bowel Obstruction in the Adult: Classic Radiographic and CT Findings, Etiology, and Mimics. Radiology. 2015; 275 (3): p.651-663.doi: 10.1148/radiol.2015140916 . | Open in Read by QxMD
  17. Brandt ML. Intestinal malrotation in children. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: January 3, 2017. Accessed: March 28, 2017.
  18. Midgut volvulus. Updated: March 28, 2017. Accessed: March 28, 2017.

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