What two diagnoses can be confirmed by these images?
Intestinal malrotation and midgut volvulus.
How is intestinal malrotation confirmed here?
The position of the DJ flexure is key. It should be to the left of midline at at the level of the duodenal cap on a straight film. Here, it clearly doesn't cross the midline.
What anatomically, predisposes them to volvulus?
In malrotation, the small bowel mesentery has a narrow base (as highlighted by the low position of the DJ flexure) which predisposes the midgut to volve on the narrow mesenteric pedicle.
Why is malrotation so important?
In children with malrotation, there is predisposition to volvulus (as in this case) and without surgical intervention, risk of bowel necrosis.
Contrast demonstrates a malplaced DJ flexure and a corkscrew appearance of the jejunum. This confirms both malrotation and volvulus.