Small Bowel Malrotation

For every specialist involved, small bowel malrotation is one of the more challenging and important diagnosis to make. The risk of evolving into volvolus and potentially fatal bowel ischemia calls for an early diagnosis. The radiologist can really make the difference, imaging the child bowel and recognizing normal and abnormal patterns of bowel rotation, and assessing the risk of volvulus. This paper will review the embryologic development of small bowel rotation, the clinical presentation of malrotation and midgut volvulus, the radiologic tools available for prenatal and postnatal diagnosis of malrotation, and patient management in both neonates and older patients. Some particular cases are also highlighted, like malrotation associated with heterotaxy syndromes. A practical approach is suggested with some technical suggestions and their pros and cons. Familiarity with clinical signs, upper gastrointestinal imaging patterns and possible surgical management may help to increase confidence in diagnosing small bowel malrotation and midgut volvulus