Intestinal malrotation with multiple congenital anomalies

Intestinal malrotation (IM) occurs secondary to abnormal midgut rotations. It is a common and often devastating cause of neonatal bowel obstruction. Associated anomalies in IM is high, up to 60%. We present a case malrotation without volvulus in a day 8 of life neonate associated with duodenal atresia (fenestrate web), annular pancreas, polysplenia, preduodenal portal vein and anorectal malformation (rectoperineal fistula). This case offered a unique presentation of malrotation with multiple anomalies, and highlights need of high index of suspicion of additional congenital anomalies when managing malrotation.