Malrotation is a congenital condition where the abnormality of the bowel occurs. This means that the baby will have intestines that are not located at the right position. This leads to many problems such as Ladd’s bands and volvulus. Let us learn more about intestinal malrotation.
A developing fetus is about 5 weeks old, the intestine exits the fetal body and enters the amniotic fluid. There it gets more space to continue its growth. After about 10 weeks, the intestine again enters the abdomen and undergoes two rotations. At times, the intestine does not make the necessary turns and leads to intestinal malroation.
The condition itself is not of much health concern. However, it can lead to two serious complications as mentioned in the previous paragraph. About 1 in 500 children born in US suffer from malrotation. Many babies never develop any symptoms till they grow up to become children, teens and even adults. A few may never develop any problems all their life and the condition almost goes undetected.
The statistics show that babies who are born with intestinal malrotation get diagnosed as follows:
- 25 to 40% cases are detected in the first week of life
- 50 to 60% cases diagnosed within the first month of life
- 75 to 90% cases detected by the age1
Symptoms of Malrotation
In many children, the symptoms usually appear before they reach their first birthday. However, some never develop symptoms till they are older and few never develop any symptoms.
Symptoms appear only when the intestine gets blocked or the blood flow is cut off. The symptoms include:
- Green or yellow vomit that is also called as bilious as it contains bile
- Fussiness or crying non stop
- Tiredness or appears lethargic
- Stools are irregular, the baby may develop diarrhea, or blood stools or pass no stools at all
- Heart rate and respiration are rapid
- child looks sick
- The belly is swollen and tender to touch
Recurrent pain in the abdomen and vomiting is observed in children with chronic, uncorrected malrotation.
The exact cause of malroatation is unknown. It suspected to have a genetic link, as some cases recur in families.
Malrotation may sometimes lead to:
- Ladd’s bands - These are tissue bands that attach themselves to the first part of the small intestine (duodenum). This causes a blockage at the junction, where the duodenum meets the first part of the large intestine (colon). This prevents the food from passing through.
- Volvulus - The intestines tend to twist sharpy; squeezing the blood vessels that carrythe blood into the intestines. As the blood supply is cut off it can lead to damage and death of the intestinal tissue.
Intestinal malrotation is often detected after examination of the child and carrying out diagnostic tests. These tests include X-rays, CT scans and ultrasound of the abdomen. The doctor may carry out barium X-ray to observe the intestines more clearly and spot the location of the blockage.
The treatment for malrotation is surgery, especially when the child exhibits the symptoms. In case of volvulus, surgery is immediately required as it is a life-threatening condition.
The surgery options for malrotation include removal of the intestines. A nasogastric (NG) tube is inserted through the nose of child to empty the stomach. IV fluids are given to prevent dehydration, provide nutrition and antibiotics. The child will be given general anesthesia before the surgery.
The surgeon will make a small incision above the belly button and remove the intestines through it. The intestine will be untwisted and the Ladd’s band will be cut from the duodenum. If the intestines are pink and appear healthy, the surgeon will fold the small intestine into the right side of the belly and the large intestine into the left side of the stomach. This way the intestines won’t twist in the future. The way the intestines are placed now is not the normal positioning of the intestines. This means the appendix is not lying in its normal position. In case, the child develops appendicitis in the future, it will be hard to diagnose. Thus, the surgeon will remove the appendix during this surgery.
The incision is then closed and the child monitored for the next 24 to 48 hours. In case the blood flow is not good, another surgery will be performed to remove the segment of the intestine that is not healthy.
In case of damaged or dead tissue of intestine, due to lack of blood flow. The surgeon will remove that segment and keep the healthy tissue as much as possible. In some cases, two small openings called stoma will be made on the child’s body. Each open end of the cut intestine will be attached to these openings. One of the openings allows waste to collect in the plastic pouch attached on the outside. The other opening is to clean the lower intestine. This procedure is called Ostomy and the parents will be instructed well in advance regarding the procedure and its aftercare.
The ostomy in most cases is a temporary procedure. When the intestine is healthy, the surgeon will carry out another surgery to attach the two ends of the intestine and close the stoma. In case a large segment of intestine is removed, the ostomy will be a permanent procedure.
Malrotation can lead to many life-threatening complications. This can be treated only with surgery. Speak to the doctor or surgeon in detail regarding the condition and its long term effects on your child’s health.
Written by: healthplus24.com team
Date last updated: January 30, 2015