Snapshot A 10-day-old baby boy is brought to the emergency room for repeated episodes of vomiting. His mother describes the vomit as green and yellow. On physical exam, the physician has difficulty at first locating the heartbeat, but finally hears a heartbeat on the right side of the chest. Suspicious, he sends the baby for abdominal radiography and upper GI series. Imaging reveals dilated bowel loops and a “birds beak” appearance of bowel. Introduction Malrotation login to view 3 more bullets Midgut volvulus login to view 5 more bullets Cecal volvulus login to view 2 more bullets Associated conditions login to view 6 more bullets Malrotation with midgut volvulus is a surgical emergency Epidemiology Most common in newborns Males > females 80% of cases are newborn Elderly population can have malrotation, but volvulus is less often Presentation Symptoms login to view 8 more bullets Physical exam login to view 4 more bullets Imaging Abdominal radiography login to view 3 more bullets Upper GI imaging with barium enema login to view 3 more bullets Differential Diagnosis Intussusception Intestinal atresia Treatment Malrotation without volvulus login to view 1 more bullet Malrotation with volvulus (symptomatic or acute abdomen) login to view 2 more bullets PREVENTION Prevention login to view 2 more bullets Complications Bowel necrosis and perforation Sepsis Prognosis Most with resolution of symptoms after surgery Good prognosis login to view 3 more bullets