In the United States, about one of every children is born with intestinal malrotation. A small minority of people who have intestinal malrotation never experience symptoms, and sometimes live their whole lives without being diagnosed.
While many boys with intestinal malrotation develop symptoms earlier, malrotation occurs equally in boys and girls. Many children with intestinal malrotation also have another congenital present at birth problems. These may involve the abdominal wall or the digestive system, the heart, or the liver or spleen. Intestinal malrotation is usually not evident until the intestine becomes obstructed by Ladd's bands or twisted. When the intestine is obstructed by Ladd's bands or when the blood supply is twisted, symptoms may include:.
To confirm a diagnosis of intestinal malrotation, patients have various blood tests and diagnostic imaging studies done. These tests include:. The fluids keep them from becoming dehydrated, and the antibiotics prevent infections. A nasogastric tube is placed from the nose into the stomach to prevent gas buildup in the stomach. As soon as possible, twisted bowel surgery is performed to untwist the intestine.
If it is not damaged too badly, the intestine's circulation may be restored after it is untwisted. If the intestine is healthy, an operation called the Ladd's procedure is performed to repair the malrotation. If the surgeons are not sure the intestine will receive an adequate blood supply even after untwisting, they may need to perform another operation.
This is usually performed within 24 to 48 hours of the first operation. If they find a section of intestine that is damaged so badly it can not be saved, that portion is removed. To allow the intestine to heal, the surgeons sometimes have to create a small bowel stoma, an opening through the abdominal wall to the skin that diverts the body's waste products into a collection bag.
The stoma may be removed after several weeks to restore normal intestinal function. The long-term outcome is generally very good when intestinal malrotation is surgically corrected before intestinal damage occurs. Older children also tend to do well. However, when a large portion of intestine has to be removed because of intestinal injury, the remaining intestine has trouble absorbing nutrients and fluids.
The child's regular diet may need to be supplemented or replaced with total parenteral nutrition TPN. TPN is a high-calorie solution that is given intravenously to bypass the intestine. Malrotation happens equally in boys and girls.
But more boys have symptoms by the first month of life than girls. Babies with other health issues have a greater risk of having a malrotation. These problems include diaphragmatic hernia, omphalocele, and duodenal atresia. The symptoms of malrotation may look like other health problems. Your child's healthcare provider will ask about your child's health history. They will also give your child an exam. Your child may also need tests that show pictures of the inside of their body imaging studies.
A CT scan shows detailed images of any part of the body. CT scans are more detailed than general X-rays. For this test, your child will swallow barium. This is a metallic liquid that coats the inside of the organs. This helps them show up better on an X-ray. It can show an abnormal location for the small intestine, blockages, and other problems.
This test looks at the large intestine. The healthcare provider will put barium into your child's rectum as an enema. The healthcare provider will take X-rays of the belly. This test is done to check for volvulus. It will also depend on how severe the condition is. A volvulus is a life-threatening problem. Your child may need IV intravenous fluids to prevent dehydration.
They may also need antibiotic medicine to prevent an infection. Since the appendix is located in a different area than usual, it would be difficult to diagnose appendicitis in the future. An appendectomy surgical removal of the appendix is also usually done. If the blood supply to the intestine is in question, the intestine may be untwisted and placed back into the abdomen.
Another operation will be done in 24 to 48 hours to check the health of the intestine. If it appears the intestine has been damaged, the injured section may be removed. If the injured section of intestine is large, a significant amount of intestine may be removed. In this case, the parts of the intestine that remain after the damaged section is removed cannot be attached to each other surgically. A colostomy may be done so that the digestive process can continue.
With a colostomy, the two remaining healthy ends of intestine are brought through openings in the abdomen. Stool will pass through the opening called a stoma and then into a collection bag.
The colostomy may be temporary or permanent, depending on the amount of intestine that needed to be removed. The majority of children with malrotation who experienced a volvulus do not have long-term problems if the volvulus was repaired promptly and there was no intestinal damage.
Children with intestinal injury who had the damaged part removed may have long-term problems. When a large portion of the intestine is removed, the digestive process can be affected. Nutrients and fluids are absorbed from food in the small intestine. Removing a large segment of the intestine can prevent a child from getting enough nutrients and fluids.
Intestinal Malrotation and Volvulus. Appointments and Referrals. When the intestine becomes twisted or obstructed, the symptoms may include: Vomiting bile green digestive fluid Drawing up the legs Abdominal pain Swollen abdomen Diarrhea Constipation Rectal bleeding Failure to thrive Rapid heart rate Rapid breathing Bloody stools The symptoms of malrotation and volvulus may look like other conditions or medical problems. These tests may include: Blood tests. Tests to check electrolytes.
Stool guaiac. A test to detect blood in stool samples. A diagnostic imaging procedure using a combination of X-rays and computer technology to produce horizontal, or axial, images often called slices of the body.
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