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Malrotation
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
The 3 millimeter sealer is an excellent dissecting device and can be used in safe energy in close approximation to both the gallbladder and the small bowel Technique: Laparoscopic Repair of Duodenal Atresia, Ladd's Procedure, and... · 1:30
Technique: Laparoscopic Repair of Duodenal Atresia, Ladd's Procedure, and...
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Laparoscopic Repair of Duodenal Atresia, Ladd's Procedure, and Meckel's Diverticulectomy in a Newborn using Just Right stapler by Dr. Steven Rothenberg.
video15:01 · Nov 2018
Malrotation Infant
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Surgical technique video demonstrating laparoscopic Ladd procedure in an infant with malrotation presenting with bilious vomiting. Shows systematic division of Ladd bands, duodenal mobilization, bowel derotation, and appendectomy using 3mm
video9:22 · May 2026
In adults, 2 centimeters is the cutoff size for mesenteric vessel pseudoaneurysms at which intervention is typically considered. — Todd Ponsky, Malrotation - Volvulus - Meconium Ileus - Solid Organ Injury: Update Course 2015 · 26:19
Malrotation
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Dr. Soldes discusses the classifications of malrotation through the presentation of case presentations. Discussion topics include Ladd's procedure, volvulus, non-bilious emesis, redundant duodenum, gastroesophageal reflux, and laparoscopy.
video42:31 · Nov 2018
Malrotation - Volvulus - Meconium Ileus - Solid Organ Injury: Update Course 2015
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Dr. Kenneth Azarow,Surgeon-in-Chief for Doernbecher Children’s Hospital,presents on malrotation-volvulus, meconium ileus, andsolid organ injury. Topics covered by Dr. Azarow include malrotation and heterotaxy, non rotation, right and leftat
video27:04 · Nov 2018
Malrotation Rapid Fire Session: Update Course 2015
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During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015, Dr. Kenneth Azarow,Dr. Kenneth Azarow, Surgeon-in-Chief for Doernbecher Children’s Hospital, presents on malrotation-volvulus. Topics discussed includemalrotatio
video8:59 · Jan 2019
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
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In this episode, Dr. Levitt and Dr. Frischer discuss the workup and management for a patient with suspected proximal Hirschsprung disease. Listen as they walk you through a their thought process and what to consider in these complex patient
podcast8:42 · Feb 2021
Some believe part of the benefit of Ladd procedure is widening the mesentery plus causing scar tissue that helps bowel adhere in a configuration preventing midgut volvulus. — Meera Kotagal, Malrotation with Dr. Meera Kotagal · 10:01
Malrotation with Dr. Meera Kotagal
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In this podcast, we cover the basics of malrotation including embryology, presentation, differentiation, diagnosis, surgical approach, and post operative management with Dr. Meera Kotagal.
Host: Em Tombash
Animations to understand the
podcast13:25 · May 2023
Expert statements from the recordings in this collection.
Malrotation
In the first two months of life, about 70% of volvulus cases occur, and by the first two years of life, 90% of volvulus cases that are going to occur do occur
In 20% of cases with true malrotations of the fore and mid-gut, you have a normal barium enema
A normal ultrasound does not rule out volvulus, supported by multiple studies
Ladd's bands do not cause midgut volvulus
Jack4:02
Ladd's bands are thought to be an attempt of the body to fuse the cecum to the lateral peritoneal wall
Wit37:16
The key reason to operate on an asymptomatic patient is to avoid midgut volvulus
Jack3:52
The critical measurement is the distance between the ligament of Treitz and the ileocecal junction to prevent volvulus, though nobody knows the exact distance required
Jack4:56
In patients with heterotaxy syndromes who have asymptomatic malrotations and undergo operations, the complication rate is remarkably high, between 30 and 50%
In a study from Edmonton on heterotaxy patients who underwent procedures for malrotation, the complication rate was about 50%
In a study by Papillon from Children's LA of about 200 heterotaxy patients, a quarter got screening upper GIs and three quarters did nothing; in 4 years there was only one case of volvulus, and in patients without bilious emesis and symptoms, no cases of volvulus
In the heterotaxy subgroup, the risk of volvulus in the early period (4-5 years) is actually very low if patients are not symptomatic
When bowel loops are dilated, this will always give you a low-lying ligament of Treitz
Todd Ponsky11:53
Atypical malrotation with a low-lying ligament of Treitz has some data showing lower risk of volvulus, though the data is not strong
In patients with rotation abnormalities, reversed mesenteric vessels may or may not be seen; it doesn't definitively indicate malrotation
Jack41:01
In Jack's series of several hundred patients, there was never a case where the vessels were normal in a patient who had risk for volvulus (narrow base mesentery), so they use it as a screening test in sick patients
Jack41:15
Upper GI is clearly better than ultrasound for diagnosing malrotation, but in a sick patient who can't get to radiology, ultrasound can be useful
Jack41:54
Laparoscopic Ladd's procedure can be very effective even in a newborn, though if there's too much twist and no room, conversion to open may be necessary
Tim Kane8:18
In cardiac patients between first stage and Glenn procedure who get G-tubes, Nissen fundoplication is often requested because they vomit and are too small for PEGs
Tim Kane14:42
A 45-minute Nissen at pressures of 8 is tolerated by cardiac patients between stages
Tim Kane14:56
In a published study combining experience with Kansas City, the cardiac risk group did not stratify out to be at higher risk for reflux complications; neurologically impaired CP kids maybe, but not cardiac kids
Yama does not operate on asymptomatic malrotation as long as the patient has non-bilious vomiting, is gaining weight, and is clinically well
If a patient has a narrow pedicle, the patient always has vomiting and is symptomatic
Ladd's bands themselves are not risky; the risk is bilious vomiting and narrowing of the pedicle
In situs inversus or ambiguous cases, measuring the distance between ligament of Treitz and ileocecal junction matters regardless of where the bowels are; if less than half the diameter of the abdominal cavity, intervention is needed
Jack39:27
Malrotation - Volvulus - Meconium Ileus - Solid Organ Injury: Update Course 2015
In heterotaxy syndrome with right atrial isomerism, there is a higher incidence of malrotation compared to left atrial isomerism.
Todd Ponsky3:54
In a Texas Children's series of 95 consecutive heterotaxy patients with malrotation, three-quarters underwent Ladd's procedure with no post-operative volvulus but 11% developed small bowel obstruction requiring admission and often surgery.
In the same Texas Children's series, 25% of heterotaxy patients were observed without surgery and had no small bowel obstruction or volvulus during 10-15 year follow-up.
Appendectomy carries a slight long-term complication rate from adhesions.
Kenneth Azarow6:56
A low-lying ligament of Treitz defines malrotation, not simply the duodenum crossing midline, because a floppy duodenum can cross midline without malrotation.
Kenneth Azarow8:59
Current literature shows overall success rates for meconium ileus enema reduction are declining on first attempts.