Malrotation of the midgut in infants and children: a 25-year review.

Seventy-four patients were operated on at Childrens Hospital of Los Angeles between 1951 and 1977 for abnormalities of intestinal rotation with or without volvulus. The mortality in this group of patients was 4% and represents a significant improvement from the 23% mortality previously reported from this institution between 1937 and 1951. Neonatal patients had bilious vomiting and signs of high intestinal obstruction while older children had a more chronic course characterized by intermittent episodes of abdominal pain. Evaluation with contrast studies and early celiotomy is mandatory to prevent bowel necrosis. We outline the associated gastrointestinal anomalies and management of these combined anomalies.