Intestinal Malrotation (Gastroschisis and Omphalocele)

Drawing of a patient with an intestinal malrotation and an interruption of the intestinal continuity. The small bowel lies on the right side of the midline, the colon on the left side in the abdominal cavity. So-called malrotations occur in gastroschisis and omphalocele as obligatory additional anomalies. In malrotation the normal fetal torsion and fixation of the intestine did not take place. In the presented case the fetal torsion occurred only by 90° instead of the normal 270° (three times 90° in counter-clock direction from the sagittal plane); therefore, the colon lies on the left and the small bowel on the right side = nonrotation in a case of omphalocele. In addition, other intestinal malformations occur in gastroschisis and omphalocele, namely, atresia, Meckel's diverticulum, and others. In the presented case the atresia concerns the small bowel which is recognizable by to the total interruption of the intestinal continuity, the proximal intestinal dilatation (compare the diameter of the latter with that of the distal small bowel at 7 versus 10 in the drawing) and the mesenteric gap (at 9). An atresia may be caused in the individual case by a strangulation of the small bowel at the abdominal cleft in gastroschisis, and at a narrow hole of the abdominal wall in omphalocele.