Intestinal Malrotation and Midgut Volvulus

Intestinal malrotation is an abnormal arrangement and fixation of the intestine that develops before birth. Because the midgut does not rotate and anchor normally around the superior mesenteric artery, its mesenteric attachment may remain unusually narrow. The bowel can then twist around the superior mesenteric artery and vein; this complication is midgut volvulus. Volvulus is a time-critical surgical emergency. The twist can obstruct the duodenum and compromise blood flow to nearly the entire small bowel and part of the colon. Ischemia may progress to necrosis within hours. Green or yellow-green emesis in a neonate is therefore treated as bilious vomiting and escalated immediately, even when the abdomen is soft or only slightly distended. The LPN/LVN's role is to recognize the pattern, perform a focused assessment, begin ordered stabilization measures, and communicate deterioration without waiting for a complete diagnostic explanation.