Background
During normal abdominal development, the 3 divisions of the GI tract (ie, foregut, midgut, hindgut) herniate out from the abdominal cavity, where they then undergo a 270º counterclockwise rotation around the superior mesenteric vessels. Following this rotation, the bowels return to the abdominal cavity, with fixation of the duodenojejunal loop to the left of the midline and the cecum in the right lower quadrant.
Intestinal malrotation, also known as intestinal nonrotation or incomplete rotation, refers to any variation in this rotation and fixation of the GI tract during development. Interruption of typical intestinal rotation and fixation during fetal development can occur at a wide range of locations; this leads to various acute and chronic presentations of disease. The most common type found in pediatric patients is incomplete rotation predisposing to midgut volvulus, requiring emergent operative intervention.
The first reports of intestinal malrotation were based on surgical and autopsy findings and occurred prior to 1900; however, the first description of the embryologic process of intestinal rotation and fixation was not published until 1898.
In 1923, Dott was the first to describe the relationship between embryologic intestinal rotation and surgical treatment.
In 1936, William E. Ladd wrote the classic article on treatment of malrotation. His surgical approach, now known as the Ladd procedure, remains the cornerstone of practice today.