Malposition of the intestine malposition malrotation volvulus "midgut volvulus"

BACKGROUND: Malposition of the intestine constitutes an interesting though difficult subject for many medical specialists. The remarkable absence of unambiguous terms and definitions makes it difficult to deal with the subject satisfactorily. The aim of this article is to clarify terms and definitions, and to present essential aspects of the clinical signs and symptoms, diagnosis and therapy of this condition. METHODS: Based on a brief representative case report of a child with acute midgut volvulus clinical signs and symptoms as well as diagnostic work-up are discussed. A detailed study of the literature shows the increasing experience in this topic to prevent the development of potentially disastrous sequelae. RESULTS: In addition to a high degree of suspicion when being confronted with clinical signs and symptoms such as bilious vomiting immediate diagnostic work-up is based on ultrasound examination of the abdomen and upper gastrointestinal series. In the case of confirmed volvulus surgery according to the concepts presented by William E. Ladd has to be performed immediately. The decision as to whether preventive surgery should be performed in cases of "asymptomatic malposition" is a difficult one. An incidentally discovered nonrotation is no indication for surgery. CONCLUSIONS: Malposition of the intestine represents a challenging topic in abdominal surgery. The affected patient needs thorough investigation and specific surgical treatment. The prime purpose is to prevent the ultimate catastrophe, which would be loss of the small intestines.