Intestinal malrotation without volvulus in infancy and childhood.

Intestinal malrotation without volvulus in infants and children is often difficult to diagnose because of less dramatic clinical features, e.g. failure to thrive and intermittent bile stained vomiting, compared to the patients with volvulus. A plain x-ray of the abdomen may show the characteristic "double bubble sign", otherwise a barium meal will give the diagnosis. A follow-up study of 18 patients of whom 14 had an operation showed that all but one were free of symptoms after a median observation period of 205 months (range 20-317). It is concluded that any patient presenting with a symptomatic intestinal malrotation should be offered an operation except for the type with a mobile caecum.