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Intestinal Malrotation

(Abnormal Rotation of the Intestines; Malrotation of the Bowel)

By William J. Cochran, MD, Associate, Department of Pediatrics GI and Nutrition; Clinical Professor, Department of Pediatrics, Geisinger Clinic, Danville, PA; Temple University School of Medicine

Intestinal malrotation is a potentially life-threatening defect in which the intestines do not move into their normal location in the abdomen as the fetus is developing.

  • The cause of this defect is not known.

  • Typical symptoms include vomiting, diarrhea, and abdominal pain and swelling.

  • The diagnosis is based on different kinds of x-rays.

  • Intestinal malrotation is an emergency that requires surgery.

Malrotation can cause the intestines to be blocked. Because the small intestine is not anchored as it should be, it may twist (volvulus), cutting off the blood supply to the intestines. Why the intestines do not move into the correct location in the abdomen is not known.


Infants with intestinal malrotation can suddenly develop vomiting, diarrhea, and abdominal pain and swelling, and these symptoms can also come and go.

If the blood supply to the middle of the intestine is completely cut off because of a volvulus, sudden, severe pain and vomiting develop.

Bile, a substance formed in the liver, may be vomited, making the vomit appear green. Eventually, the abdomen swells.


  • X-rays of the abdomen

  • Barium x-rays

If an infant is vomiting bile, doctors take x-rays of the abdomen to look for the blockage. X-rays also are taken after barium is placed the infant's rectum (called barium enema) or swallowed by the infant. Barium looks white on x-rays and outlines the digestive tract, showing the contours and lining of the esophagus, stomach, and small intestine. Barium x-rays can help doctors see whether the lower intestines are in an abnormal position.


  • Emergency surgery

Treatment of intestinal malrotation, including fluids given by vein (intravenously) and emergency surgery, must begin within hours. If not treated rapidly, the defect can result in loss of intestinal tissue or death.