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Incomplete bowel turn
Last reviewed: 07.07.2025
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Incomplete intestinal rotation is a condition in which the normal development of the intestine is disrupted during the intrauterine period and it does not occupy its normal place in the abdominal cavity.
During embryonic development, the primitive intestine emerges from the abdominal cavity. When it returns, the large intestine normally rotates counterclockwise, with the cecum taking its place in the right lower quadrant. Incomplete rotation, in which the cecum is located elsewhere (usually in the right upper quadrant or epigastrium), can lead to bowel obstruction due to retroperitoneal bands stretched across the duodenum or to volvulus of the small intestine, which, in the absence of normal peritoneal attachments, twists on its narrow, pedunculated mesentery.
[ Symptoms of malrotation
Clinical manifestations in patients with incomplete rotation may appear in the first year of life or in adulthood and include acute abdominal pain and vomiting with bile, acute intestinal volvulus, typical reflux symptoms, or chronic abdominal pain. Vomiting with bile in an infant is an emergency and requires urgent evaluation to ensure that the child does not have incomplete rotation or midgut volvulus; if untreated, the risk of developing intestinal infarction and subsequent short bowel syndrome or death is very high.
Diagnosis of incomplete intestinal rotation
Plain abdominal radiography should be obtained immediately. If small bowel dilation and/or a small amount of air distal to the duodenum are noted, midgut volvulus is indicated, and further evaluation and treatment should be undertaken promptly. Barium enema usually demonstrates incomplete rotation, with the cecum located outside the right lower quadrant. If the diagnosis remains unclear, serial upper GI films should be obtained with caution.
Treatment of incomplete intestinal rotation
Incomplete intestinal rotation and midgut volvulus are an emergency situation requiring immediate surgery, which consists of a Ladd operation with destruction of the peritoneal bands and elimination of the midgut volvulus.
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