Malrotation with or without Volvulus
What Is Malrotation?
Malrotation is a congenital abnormality where the intestines do not rotate properly during fetal development. As a result, the intestines are positioned abnormally in the abdomen, which can lead to complications like obstruction or volvulus — a twisting of the bowel that can cut off blood flow.
This condition is usually diagnosed in infants but can also present in older children or even adults with chronic gastrointestinal symptoms.
What Is Volvulus?
Volvulus occurs when the bowel twists around itself and the tissue that supports it (the mesentery), cutting off blood supply to part of the intestine. This is a life-threatening emergency that requires urgent surgical intervention.
Signs and Symptoms
Symptoms of malrotation and volvulus vary by severity and age, but may include:
- Bilious (green) vomiting
- Severe abdominal pain or bloating
- Bloody stools
- Lethargy or poor feeding (in infants)
- Failure to thrive or chronic digestive symptoms (in older children)
Diagnosis and Evaluation
Evaluation typically involves imaging studies, such as:
- Upper GI series: The most common test used to confirm malrotation
- Abdominal X-rays or ultrasound: May suggest obstruction or volvulus
Treatment Options
Treatment depends on the presence of volvulus. If volvulus is present, emergency surgery is required to untwist the bowel and remove any nonviable sections. The standard procedure for both cases is called a Ladd’s procedure, which corrects the positioning of the intestines and reduces the risk of future volvulus.
Post-operative care typically includes a short hospital stay with monitoring for feeding tolerance, infection, and recovery of bowel function.
