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Malrotation midgut development — MRCPCH TAS MCQ

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HardEmbryologyMalrotation midgut developmentMRCPCH TAS

A 3-week-old has bilious vomiting and shock. Upper gastrointestinal contrast study shows an abnormal duodenojejunal flexure and corkscrew appearance. What is the most likely embryological mechanism?

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Correct answer: C — Abnormal rotation and fixation of the midgut

Malrotation results from abnormal rotation and fixation of the midgut, predisposing to volvulus and bilious vomiting. Failure of duodenal recanalisation causes duodenal atresia, usually with a double-bubble appearance. The pearl is that bilious vomiting in a neonate is a surgical emergency until proven otherwise.

Reference: Gray's Anatomy; Nelson Textbook of Pediatrics; RCPCH Theory examination syllabi