[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Embryology](https://durgical.com/en/embryology/) › [Digestive system](https://durgical.com/en/embryology/#a-digestive) › Malrotation and midgut volvulus [Embryology](https://durgical.com/en/embryology/) · [Digestive system](https://durgical.com/en/embryology/#a-digestive) # Malrotation and midgut volvulus - Malformation If the gut does not finish turning, it is poorly anchored and can twist on its artery: green vomit in a baby is an emergency. Updated 2026-11-01 **See it in 3D:** [Jejunum](https://durgical.com/en/anatomy/jejunum/) · [Duodenum](https://durgical.com/en/anatomy/duodenum/) · [Cecum](https://durgical.com/en/anatomy/cecum/) · [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/) · [Superior mesenteric artery](https://durgical.com/en/anatomy/superior-mesenteric-artery/) · [Mesenteric veins](https://durgical.com/en/anatomy/superior-mesenteric-vein/) ## Key points - Cause: the midgut loop does not complete its 270° counterclockwise rotation (non-rotation, or rotation of only 90°). - Findings: a high cecum, Ladd bands over the duodenum and a narrow-based mesentery. - Key sign: bilious vomiting in a newborn or infant, treated as volvulus until proven otherwise. - Upper GI series: duodenojejunal junction to the right of the spine; in volvulus, a corkscrew duodenum. - Ultrasound: superior mesenteric vein to the left of the artery and the whirlpool sign in volvulus. - Associated with congenital diaphragmatic hernia, abdominal wall defects and heterotaxy. ## What it is Malrotation is absent or incomplete rotation of the midgut loop around the superior mesenteric artery. The cecum stays high, held by Ladd bands that cross the duodenum, and the base of the mesentery is narrow. That narrow base lets the bowel twist on itself (volvulus) and cut off its own blood supply, risking necrosis of the entire midgut. ## Embryological cause - The midgut loop does not rotate, leaving the small bowel on the right and the colon on the left, or it rotates only 90°. - The cecum fails to descend and sits in the right upper quadrant or epigastrium, held by peritoneal (Ladd) bands that cross the duodenum. - The root of the mesentery, which should run obliquely from the duodenojejunal flexure to the right iliac fossa, stays short and narrow. - Variant: reversed (clockwise) rotation, with the transverse colon behind the superior mesenteric artery. ## How it presents - Acute volvulus: sudden bilious vomiting and irritability, then blood in the stool, distension and shock if ischaemia develops. - Duodenal obstruction by Ladd bands without volvulus. - Chronic forms in older children: recurrent abdominal pain, vomiting and poor growth. - It may cause no symptoms and be found on imaging. - Associations: congenital diaphragmatic hernia, omphalocele, gastroschisis, heterotaxy and intestinal atresias. ## Diagnosis - Urgent upper GI contrast study for bilious vomiting: malpositioned duodenojejunal junction; in volvulus, a corkscrew appearance. - Doppler ultrasound: reversed relationship of the superior mesenteric vein and artery; whirlpool sign. - A plain X-ray can be normal and does not rule out volvulus. - Treatment is surgical (Ladd procedure). ## Memory aid A half-turned gut is a rope with no anchor: one nudge and it winds itself around its own artery. Green vomit means the bowel is in danger. ## Test yourself Think of the answer, then tap the question to see it. ## What structure is the axis of torsion in midgut volvulus? The superior mesenteric artery; when the narrow mesentery twists around it, blood supply to the whole midgut is cut off. ## What are Ladd bands? Peritoneal bands that fix the malpositioned cecum to the posterior wall and cross the duodenum, which they can obstruct. ## Which study confirms malrotation in an infant with bilious vomiting? An upper GI contrast series, showing the duodenojejunal junction to the right of the midline. ## Which malformations are associated with malrotation? Congenital diaphragmatic hernia, omphalocele, gastroschisis and heterotaxy, among others. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/embryology/malrotation-and-midgut-volvulus/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Jejunum](https://durgical.com/en/anatomy/jejunum/) - [Duodenum](https://durgical.com/en/anatomy/duodenum/) - [Cecum](https://durgical.com/en/anatomy/cecum/) - [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/) - [Superior mesenteric artery](https://durgical.com/en/anatomy/superior-mesenteric-artery/) - [Mesenteric veins](https://durgical.com/en/anatomy/superior-mesenteric-vein/) ## Related - [Midgut: physiological herniation and rotation](https://durgical.com/en/embryology/midgut-physiological-herniation-and-rotation/) - [Mesenteries, the omental bursa and the spleen](https://durgical.com/en/embryology/mesenteries-the-omental-bursa-and-the-spleen/) - [Duodenal atresia and stenosis](https://durgical.com/en/embryology/duodenal-atresia-and-stenosis/) - [Congenital diaphragmatic hernia](https://durgical.com/en/embryology/congenital-diaphragmatic-hernia/) - [Omphalocele and gastroschisis](https://durgical.com/en/embryology/omphalocele-and-gastroschisis/) - [Jejunal and ileal atresia](https://durgical.com/en/embryology/jejunal-and-ileal-atresia/) - [Biliary atresia](https://durgical.com/en/embryology/biliary-atresia/) [← All of embryology](https://durgical.com/en/embryology/) Educational content on embryonic development; not a guide to prenatal diagnosis or to medicines in pregnancy and no substitute for a health professional's advice. No doses are given. Sources: [Embryology, Midgut](https://www.ncbi.nlm.nih.gov/books/NBK553156/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Intestinal Malrotation](https://kidshealth.org/en/parents/malrotation.html) (Nemours KidsHealth, 2021); Langman's Medical Embryology, 13th ed., ch. 15: Digestive System (Wolters Kluwer, 2015). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/embryology/malrotation-and-midgut-volvulus/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/embryology/malrotation-and-midgut-volvulus/