Intestinal malrotation--experience with 56 patients.

Intestinal malrotation is a common cause of upper gastro-intestinal obstruction and presents with duodenal obstruction caused by volvulus of the midgut loop. Patients are therefore at risk of catastrophic midgut infarction and it is a more frequent cause of duodenal obstruction in infants than duodenal atresia (92% in the neonatal period). Urgent upper contrast studies under surgical supervision are necessary in those patients whose plain films are not diagnostic. Rectal bleeding is an ominous sign, with 78% of patients having gangrenous bowel. Total midgut infarction is incompatible with survival in a Third-World environment.