Malrotation of the Intestines

Pediatric malrotation of the intestines is a congenital (present at birth) anomaly in which the intestines do not rotate properly during fetal development.

The condition impacts the position of the child’s small and large intestines. Surgical treatment is required to manage or prevent complications of malrotation

What causes it?

There is no known cause of malrotation of the intestines. The condition develops during the first trimester. The bowel begins as a straight tube and twists into place by week 12. Sometimes, the intestines don’t twist into their proper position, causing malrotation.

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What are the symptoms?

Malrotated intestines can cause pain and prevent digested food from passing through.

Common symptoms include:

  • Frequent vomiting that is green or yellow-green due to the presence of bile
  • Abdominal distension, or a swollen belly that is painful or tender
  • Difficulty feeding

Volvulus complication

The most serious complication of malrotation is volvulus, a life-threatening condition in which the intestines twist and blood flow is restricted. This requires emergency surgery to prevent bowel damage or loss. If left untreated, volvulus can lead to bowel obstruction, perforation, and sepsis.

When volvulus is not present, surgery to address malrotation is typically scheduled electively. The goal of the procedure is to reduce the risk of volvulus and related complications in the future.

How is it diagnosed?

Malrotation is most commonly diagnosed in infancy but can also be identified in older children and teenagers. Malrotation is diagnosed through special imaging tests, such as an upper gastrointestinal (GI) series, which uses contrast dye to show how the intestines are positioned.

How is it treated?

During surgery, the intestines will be untwisted and repositioned to reduce the risk of future twisting, using the Ladd’s procedure. The appendix is usually removed during surgery if the child’s anatomy would make diagnosing appendicitis difficult in the future.

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