During gut rotation, the primary intestinal loop rotates counterclockwise around the superior mesenteric artery. By how many degrees and what is the final position of the cecum?

• A 180 degrees clockwise; cecum in the left iliac fossa
• B 90 degrees counterclockwise; cecum remains subhepatic
• C 360 degrees counterclockwise; cecum returns to midline
• D 270 degrees total counterclockwise rotation; cecum descends to the right iliac fossa ✓

Explanation

The physiological midgut herniation and reduction involves a total 270-degree counterclockwise rotation around the superior mesenteric artery axis (when viewed from the front): 90° during herniation (prearterial limb goes right), 180° during return to abdomen. The cecum, initially in the epigastrium/subhepatic region, descends to the right iliac fossa as the colon elongates. Failure of rotation (non-rotation) or partial rotation (malrotation) can lead to Ladd's bands and midgut volvulus, a surgical emergency in newborns.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.