Midgut Volvulus with Chronic or Recurrent Gastrointestinal Symptoms in Children: A Retrospective Series of 10 Cases

Background: Midgut volvulus is a potentially devastating consequence of intestinal malrotation. Although frequently recognized in infancy as an acute surgical emergency, it may also present with recurrent gastrointestinal symptoms, delaying diagnosis. Methods: We retrospectively reviewed 10 children operated on for midgut volvulus associated with intestinal malrotation at a tertiary pediatric surgical unit between September 2016 and December 2022. Clinical manifestations, imaging, operative findings, treatment, and available follow-up were analyzed descriptively. Results: Age at surgery ranged from 11 days to 14 years. All 10 patients had a history of intermittent bilious vomiting; four also experienced recurrent abdominal pain. Ultrasonography contributed to diagnosis in all cases through findings including the whirlpool sign and/or abnormal superior mesenteric vessel relationships. Surgery confirmed midgut volvulus ranging from one to four turns. No bowel necrosis was found, and no intestinal resection was required. All children underwent open Ladd procedures, including detorsion, division of Ladd bands, widening of the mesenteric base, bowel repositioning, and appendectomy. No major early postoperative complication was documented. At the most recent clinical assessments, performed in late 2025 for five children and in 2026 for five, no recurrent volvulus or persistent vomiting or abdominal pain was reported. Conclusion: Recurrent bilious vomiting should prompt investigation for malrotation and intermittent midgut volvulus, even beyond infancy. Timely imaging and definitive surgery may prevent bowel loss.