Malrotation describes the position of small bowel mesentery. Malrotation predisposes to volvulus which is the cause of the acute presentation with bilious vomiting.

While some cases will display the classic corkscrew of volvulus on the upper GI contrast study, many will not. In these circumstances, performing an ultrasound may demonstrate the volved mesentery, bowel and vessels - especially when Doppler is employed. In this case, it clearly demonstrated to the surgical team that the bowel was volved and they needed to take the patient to theater.

In this case, there was no bowel necrosis and the bowel was de-volved and a Ladd's procedure performed.