BACKGROUND
Intestinal malrotation is a congenital disorder in which there is a failure in the rotation of the intestine, especially middle intestine during embryological development. This disorder usually occurs at 10th weeks' of gestation. Intestinal malrotation occurs in about 1: 500 live births, while symptomatic in only 1: 6000 live births. In this case peritoneal attachment of an incomplete rotated cecum (Ladd band) leads to obstruction of duodenum.

CASE
A three months old boy came to emergency room with bilious vomiting. Physical examination: severe dehydration, failure to thrive, distended abdomen and bloody stool with no bowel sound. While abdomen radiograph shows duodenal and gastric dilatation, no air reaches the ileum and the colon, which caused by entrapment as high as the duodenum.

DISCUSSION
Intestinal malrotation is a congenital anomaly that results from abnormal or incomplete rotation and fixation of the midgut during embryonic development. About 75% to 85% of these patients were diagnosed during infancy. Intestinal obstruction should be suspected in newborn and infancy presenting with bilious vomitting until proven otherwise. Delay in diagnosis may lead to serious complication.

CONCLUSION
Diagnosis of malrotation cause intestinal obstruction established by history of bilious vomiting and distended abdomen in infancy with positive physical examination supported by radiology imaging and intraoperative findings. Ladd procedure surgery is needed to repair malrotation