MALROTATION and malfixation of the intestinal tract have long been recognized as clinical entities. They have a variety of clinical presefitations. MALROTATION of two organs is relatively rare. In this case report, we present a very rare (the fifth case) of situs inversus and malrotatin of the intestrnal tract. Since the rotation of the intestinal tract And placement of the heart occurs simultaneously at the fourth week of fetal life, probably a - single etiology is responsible for such a presentation.

Chylous ascites was diagnosed in a female neonate. Following the administration of a gastrografin enema, which showed the presence of gut MALROTATION, she was operated. This led to a complete recovery and optimal weight gain. For evaluation of chylous ascites in neonates, gut MALROTATION should be considered in order to prevent volvolus and further complications.

Midgut MALROTATION is typically presented during the first few months of life but sometimes may encounter later in life, causing difficulties and mistakes in diagnosis. We reviewed records of eleven rare patients with midgut MALROTATION older than one year of age and extracted their clinical and paraclinical data. The most common presenting symptoms were bilious vomiting, recurrent abdominal pain and constipation. Five of eleven patients had presented from neonatal period. The average interval between first symptoms and surgical correction of MALROTATION was about 22 months. Some of the patients had been undergone false treatments. Most cases were diagnosed by contrast studies (upper gastrointestinal series and barium enema). Diagnosing midgut MALROTATION in older children is often delayed. This anomaly should be suspected in all children with signs and symptoms of small bowel obstruction, chronic abdominal pain and vague abdominal discomfort and in all patients of any age with abdominal discomfort who do not respond to other therapies. Contrast studies may be necessary to rule out MALROTATION in suspected patients.

In this study, 27 cases of intestinal MALROTATION were studied, most of whom underwent radiographic evaluation with radio contrast media the ratio of incidence in male to female was 2.8 to 1. Most cases manifested during the first year of life. Associated disorders were learn than thorn reported in Europe and United states (22.2%). The clinical symptoms were biliary romiting (12 cases) and nonbiliary vomiting (6 cases). Five cases manifested with constipation and one with diarea. Radiographic findings in their order of occurrence were as follows: Duodenal distention (11 cases), duodenal deformity (10 cases), delay in gastric emptying (7 cases) reflux (6 cases) and total duodenal obstruction (3 cases).

Background: Diaphyseal tibial fractures are the most frequent bone fractures in the body and are usually treated with intramedullary nailing method. However, this approach is responsible for 41% of the rotational deviation. Objectives: This study aimed to provide a radiographic evaluation method to determine tibial MALROTATION in closed fixation of tibia bone fractures during or after the operation. Methods: This study was conducted in a university hospital from May 2015 to March 2016. All patients referring to the hospital with the complaints of minor trauma around the ankle and knee requiring radiographic evaluation of both joints were enrolled in the study. The inclusion criteria included being 20 and 50 years old; having normal axial, sagittal, and coronal lower limb alignment; lacking previous lower limb injury (such as fractures of the tibia or fibula), ankle or knee sprain; not having previous lower limb surgery, metabolic or congenital bone diseases, or malignancy. In all cases, a standard Anteroposterior (AP) radiograph of the knee was taken, and then, without changing the limb position or image setting, an AP radiograph of the ankle was obtained. The overlap between the distal tibia and fibula was measured in the PACS program environment. Results: Fifty cases were included in this study. The Mean± SD ages of males and females were 29. 08± 2. 49 years and 31. 46± 2. 04 years, respectively. The range of distal tibia-fibula overlap one centimeter above the tibiotalar joint line was 7. 81 to 9. 09 mm (confidence interval of 95%), and its percentage to the fibula shaft width at the same level was 49. 43% to 54. 35%. Conclusion: According to the results, distal tibia-fibula overlap when the knee is in the true AP position, regardless of the side and gender, is 7. 81 to 9. 09 mm or 49. 43% to 54. 35%.

MALROTATION with midgut volvulus often results in gangrene of midgut with relative sparing of duodenum. An extremely unusual case of MALROTATION with isolated necrosis of distal duodenum is described with brief review of literature. Isolated duodenal necrosis in association with MALROTATION is very rare; it increases the complexity of surgery and prolongs hospital stay.

Background: Rotational deformity after intramedullary nailing is a well-known complication. Femoral MALROTATION is the most common form of malunion but it is underrecognized in part because of the difficulty in accurately assessing rotation as well as the variation that exists in normal anatomy. The aim of this study was to evaluate femoral MALROTATION following intramedullary nailing of the femur.Methods: We studied 70 patients who had referred to Imam Khomeini Hospital and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during 3-year period from 2008 to 2011. Inclusion criteria including isolated femoral shaft fracture that had undergone antegrade intramedullary nailing. Exclusion criteria including spontaneous ipsilateral tibial fracture or pelvic fracture, contralateral femoral fracture, femoral fracture that had fixed using plate or external fixator or retrograde intramedullary nailing. During operation, the patients were assessed clinically for rotational deformity and then in the postoperative follow-up period, degree of rotation was identified with CT scan. Postoperative computed tomography measurements of rotation were compared with the opposite side.Results: There were 70 patients, 56 men and 14 women. The average age of the patients was 28.21±14.39 patients (55.7%) had external rotation and 31 patients (44.3%) had internal rotation. The mean of MALROTATION degree in physical examination was 4.67 and The mean of MALROTATION degree in CT scan was 7. Degree of MALROTATION deformity, less of 5o, 5 to 10o and 10 to 15o was less of 8.6%, 75.7% and 15.7% respectively. Degree of MALROTATION didn’t relate to age, sex, fracture location and activity of the patients (P>0.05).Conclusion: Rotational deformity in 28% of the patients was equal to more 15o. This complication didn’t relate to fracture location. The patients with external rotation deformity had more symptoms than the patients with internal rotational deformity but there isn’t significant relation in this study.

Introduction & Objective: Rotation is a term implicating the normal programmed return process of bowel from physiologic hernia to abdominal cavity. 55% of this happens in the first week of life and 80% of this in the first month of life.Material & Methods: This cross-sectional study has been done on the all patients with the diagnosis of MALROTATION at Mofid hospital from 1981 till 2003.Results: There were 113 patients (76 males, 37 females). 50 patients (45%) were under one monthage, 36 patients (31%) were one month age to 12 months age and 27 patients (24%) were older than one year old. The mean of infant's age was 2.7:t. 1.2 years (minimum 1 day of age and maximum 9 years old). All the signs and symptoms of their disease and radiological studies of them have been studied in our study.Discussion: As in other studies, the ratio of males to females in our study was 2/1. All the patients under one year old came with acute or chronic bowel obstruction symptoms, whereas the older ones came with different (presentations?) manifestations, confirmed with the other studies, the main reason of this diversity are the anatomy and physiologic condition of children of this age (over one year old)?Conclusions: At the end, a prospective research to study the clinical manifestations and radiological studies of bowel melioration seem to be needed.