sometimes takes a high position, and this could give a false impression of malrotation If an US is obtained, as with possible pyloric stenosis or intussusception, an abnormal relationship between the superior mesenteric artery and vein should lead to an upper GI series As in the case of a child with an unreduced intussusception, a child with a possible volvulus should be prepared for immediate surgery The operating room and operating team should be notified IV fluid and electrolyte replacement should begin immediately Laboratory studies should be obtained, but they not add to the diagnostic evaluation A nasogastric tube should be inserted and blood cross-matched Because this entity can present even in adulthood, every physician should understand the pathogenesis and the need for emergency surgical treatment of volvulus If immediate transfer to a pediatric hospital cannot be accomplished within an hour, a laparotomy should be performed without delay