Malrotation in Childhood: Pitfalls in its Recognition and Diagnosis

Congenital anomalies of gut fixation, such as intestinal malrotation, are predominantly asymptomatic, and their true prevalence in the general population remains unclear. Symptomatic cases are rare and often present with a wide range of atypical clinical manifestations, leading to delayed diagnosis or detection only after complications arise. We report two cases of intestinal malrotation to raise medical awareness of this condition. Case 1: A 12-year-old boy presented with multiple episodes of vomiting and abdominal pain over the previous 24 hours. His history revealed recurrent, non-periodic episodes of abdominal pain, some accompanied by vomiting, over the past three years. During one such episode, he had undergone an appendectomy. Case 2: An 11-month-old girl was admitted with recurrent, prolonged episodes of vomiting over the past three months. Despite a good appetite before and after these episodes, they were initially misdiagnosed as gastroesophageal reflux disease. In both cases, malrotation was also suspected based on clinical presentation. Radiological investigations confirmed the diagnosis, which was subsequently managed surgically. However, diagnostic delays were observed in both instances. In conclusion, a high index of suspicion for intestinal malrotation is warranted in patients with unexplained, recurrent episodes of vomiting and/or abdominal pain to prevent complications and facilitate timely intervention.