Malrotation and Midgut Volvulus – Board-Style Questions

What this deck covers

malrotation and midgut volvulus in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. How the gut turns
2. Why it twists
3. When it declares
4. Reading the study
5. The vessels on ultrasound
6. Swirling on Doppler
7. A spiral of contrast
8. The plain film
9. Years of loose stools
10. No time for pictures
11. Untwisting it
12. No twist, still blocked
13. Why take the appendix?
14. The final arrangement
15. Doubtful colour
16. Found by chance
17. A hidden pocket
18. Could it happen again?

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: 180 degrees clockwise around the inferior mesenteric artery and vein, A narrow mesenteric base around the blood vessels, At school entry around five years, Right of the right pedicle, just above the gastric fundus, The superior mesenteric vein lying left of the artery, The pseudokidney sign, The string sign, Distal ileal atresia with meconium plugging, Partial twisting that blocks lymph and venous drainage, Wait for the contrast study to confirm the cause, It does not matter which direction is chosen by the surgeon, Superior mesenteric artery compression, Appendicitis would present atypically on the left, Small bowel to the left and colon to the right.

Clinical pearls from this deck

• Normal rotation: 270 degrees anticlockwise about the SMA.
• Narrow base, whole midgut on a stalk: ready to twist.
• Most declare themselves in the first month of life.
• Normal flexure: left of the left pedicle, bulb height.
• SMV left of the SMA: think of abnormal rotation.
• Vessels spiralling round the SMA: the whirlpool sign.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Gastroenterology Board Questions case decks · pediatric reference values.