Intestinal Malrotation
An intestinal obstruction is a blockage of the digestive tract that prevents the proper passage of food. Some intestinal obstructions are present at birth, while others are caused by such problems as hernias, abnormal scar tissue growth after an abdominal operation, and inflammatory bowel disease (IBD).
Malrotation is twisting of the intestines (or bowel) caused by abnormal development while a fetus is in utero, and can cause obstruction. Malrotation occurs in 1 out of every 500 births in the United States.
Some children with intestinal malrotation are born with other associated conditions, including:
Signs and Symptoms
One of the earliest signs of malrotation and volvulus is abdominal pain and cramping caused by the inability of the bowel to push food past the obstruction. When infants experience this cramping they may:
- pull up their legs and cry
- stop crying suddenly
- behave normally for 15 to 30 minutes
- repeat this behavior when the next cramp happens
Infants also may be irritable, lethargic, or have irregular stools.
Vomiting is another symptom of malrotation, and it can help the doctor determine where the obstruction is located. Vomiting that happens soon after the baby starts to cry often means the obstruction is in the small intestine; delayed vomiting usually means the blockage is in the large intestine. The vomit may contain bile (which is yellow or green in color) or may resemble feces.
Additional symptoms of malrotation and volvulus may include:
- a swollen abdomen that's tender to the touch
- diarrhea and/or bloody stools (or sometimes no stools at all)
- irritability or crying in pain, with nothing seeming to help
- rapid heart rate and breathing
- little or no urine because of fluid loss
- fever
Diagnosis
If volvulus or another intestinal blockage is suspected, the doctor will examine your child and then may order X-rays, a computed tomography (CT) scan, or an ultrasound of the abdominal area.
The doctor may use barium or another liquid contrast agent to see the X-ray or scan more clearly. The contrast can show if the bowel has a malformation and can usually determine where a blockage is located. Adults and older children usually drink barium in a liquid form. Infants may need to be given barium through a tube inserted from the nose into the stomach, or sometimes are given a barium enema, in which the liquid barium is inserted through the rectum.
Treatment
Treating significant malrotation almost always requires surgery. The timing and urgency will depend on the child's condition. If there is already a volvulus, surgery must be performed right away in order to prevent damage to the bowel.
Any child with bowel obstruction will need to be hospitalized. A tube called a nasogastric (NG) tube is usually inserted through the nose and down into the stomach to remove the contents of the stomach and upper intestines. This keeps fluid and gas from building up in the abdomen. Your child may also be given intravenous (IV) fluids to help prevent dehydration and antibiotics to prevent infection.
During the surgery, which is called a Ladd procedure, the intestine is straightened out, the Ladd's bands are divided, the small intestine is folded into the right side of the abdomen, and the colon is placed on the left side. Because the appendix is usually found on the left side of the abdomen when there is malrotation (it is normally found on the right), it is removed. Otherwise, should the child ever develop Philip Wolfson, MD
Date reviewed: April 2007