Which features define malrotation with volvulus?

• A. Non-bilious vomiting
• B. Fever and cough
• C. Bilious emesis, abdominal pain, distended rigid abdomen
• D. Painless rectal bleeding

Answer: (C)

Malrotation with volvulus causes twisting of the midgut around the superior mesenteric artery, leading to acute bowel obstruction and potential ischemia. The hallmark signs are bilious emesis, which occurs because the obstruction is distal to the entry of bile, along with abdominal pain and a distended, rigid abdomen from severe obstruction and possible peritoneal irritation or ischemia. Non-bilious vomiting would suggest an obstruction proximal to the bile duct entry, so it doesn’t fit. Fever with cough isn’t specific to this condition, and painless rectal bleeding isn’t typical of a volvulus. The combination of bilious vomiting, abdominal pain, and a distended rigid abdomen best defines malrotation with volvulus.