Malrotation and Mid-gut Volvulus

Malrotation is a defect in which the intestine does not form in the correct way in the abdomen. During development in the womb, the intestine fails to loop into the proper position. Most often malrotation is not recognized until your child experiences twisting of the intestine, which is known as a volvulus. 

When a volvulus occurs, it results in an obstruction within the intestine, preventing food from being digested correctly. Additionally, the blood supply to the intestine can be cut off, leading to death of a segment of the intestine. (1)

Symptoms of volvulus are indistinguishable from intestinal obstruction, including: 

• Vomiting, often containing bile.

• Abdominal distention.

• Children >1 year will complain of abdominal pain.

Diagnosis: Malrotation is usually not identified prior to birth. Your physician will most likely order a barium enema study, CT scan, or abdominal x-ray to aide in the diagnosis of malrotation and volvulus.

Treatment: Surgical management is required and resection of necrotic (dead) bowel may be necessary. Depending upon the extent of bowel that is removed will determine if your child will need nutritional support, and further intervention for intestinal failure and adaptation.

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References:

1. Bharadwaj S, Tandon P, Gohel TD, et al. Current status of intestinal and multivisceral transplantation. Gastroenterology Report. 2017;5(1):20-28. doi:10.1093/gastro/gow045.