Intestinal malrotation

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What is intestinal malrotation?

Malrotation is when the bowel is not in the correct position (rotation) inside the abdomen (tummy).

Some babies with malrotation may develop volvulus. This is where the blood supply to the bowel is cut off because the bowel is twisted. Volvulus usually affects babies with malrotation before their 1 st birthday.

Malrotation does not cause problems for every baby with the condition and it may go undiagnosed throughout life.

Signs of malrotation

Signs of malrotation include:

  • Not feeding well
  • Vomiting (this may be green)
  • Pain or cramps in the tummy. This might be shown as a baby crying more than usual or drawing up their legs
  • Not gaining weight or growing as expected

Causes of malrotation

During pregnancy the bowels (intestines) grow outside of the tummy (abdomen) for a short period of time. As your baby grows larger the bowel goes back inside and during this process rotates.

This process of rotation gives the bowel its usual pattern (appearance).

In malrotation, this process has not happened as expected and the bowels can become blocked or twisted.

The cause of malrotation is not known.

The chance of it developing is the same whether or not a close relative has the condition.

The condition is not caused by anything the parents have done or not done during pregnancy.

The condition is not inherited and any future pregnancy is not at an increased risk.

Complications (volvulus)

Volvulus is a complication of malrotation.

It happens when the bowel twists and blocks. This can cut off the blood supply to the bowel.

Emergency treatment is needed to prevent the bowel tissue being permanently damaged.

Badly damaged bowel tissue is not likely to recover.

Volvulus is serious and can be life threatening.

Signs of volvulus

Signs of volvulus include:

  • Green vomit
  • Abnormally fast heart rate
  • Abnormally fast breathing
  • Excessive tiredness
  • Pain when the tummy is touched
  • Bleeding from the bottom

If your baby has the above signs they should be taken to hospital as an emergency.

At the hospital

At hospital your baby may need urgent treatment including:

  • a nasogastric tube (NG tube) – a tube is placed in your baby’s nose and passed into their stomach. This will empty
    the stomach to prevent vomiting and swelling
  • intravenous fluids (drip) – your baby will be put on a drip so they can receive fluids and antibiotics

They will not be fed into their stomach.

Blood tests and X-rays will be taken.

Diagnosis

Malrotation and volvulus are diagnosed by looking at the bowels on X-rays to see if they are blocked or twisted.

Your baby is fed a liquid dye (contrast dye) that makes the bowels show up on X-rays.

X-rays are taken as the dye passes through the bowel.

Doctors can look at the X-rays to work out why the bowel is not working correctly.

This is a specialist test and babies will usually be transferred to a specialist centre like Manchester Centre for Neonatal Surgery for it.

Treatment of malrotation and volvulus

Babies with signs of malrotation or volvulus will need surgery under general anaesthetic, called the Ladd’s procedure.

Surgery for malrotation will usually take place the same day.

Surgery for volvulus will usually be carried out straight away as an emergency.

Before the operation

The surgeon will explain the operation and answer any questions you have.

Parents/guardians will be asked to sign a consent form to give permission for the operation to go ahead.

Surgery

The twisted bowel is straightened and checked it is healthy. The bowel is then placed into the tummy in a position that will stop it from becoming blocked or twisted again.

The appendix is removed to prevent appendicitis in the future.

After the operation

Most babies with malrotation will make a full recovery and are not likely to have any further complications. They will stay in hospital for a few days after the operation.

Babies who have volvulus may need damaged bowel removing. Sometimes lots of bowel will need to be removed and this can have a long-term effect on their nutrition.

It is difficult to say how long a baby with this condition will need to stay in hospital because every baby is different.

Outlook

Malrotation surgery is usually successful and babies recover well and will often go on to lead normal lives.

In a small number of cases when lots of bowel has been removed due to volvulus, the remaining bowel can’t absorb enough nutrients from milk feeds. This is called intestinal failure and requires a long period of nutrition into the blood stream called TPN (total parenteral nutrition). The outlook in these babies is highly variable.