What is a serious presentation of malrotation and volvulus?

Bilious vomiting is a significant presentation of malrotation and volvulus because it indicates the obstruction of the gastrointestinal tract. In cases of malrotation, the intestines are improperly positioned, which can lead to a volvulus, where the intestines twist around themselves. This twisting can compromise blood flow and lead to ischemia. As a result, the bowel cannot properly move content through the digestive system, causing bile to back up into the stomach, which is then expelled as vomit. This type of vomiting is characterized by a greenish-yellow color due to the presence of bile.

In contrast, severe constipation, pallor of the skin, and fever above 101°F may have various other causes and are not specific indicators of malrotation or volvulus. Severe constipation can occur for many reasons, pallor might suggest anemia or shock rather than an obstructive process, and fever may indicate an infection rather than a direct sign of intestinal obstruction. Thus, bilious vomiting serves as a critical clinical sign that necessitates immediate evaluation and intervention in the context of suspected malrotation and volvulus.