Malrotation

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What is malrotation?

Malrotation is a congenital abnormality occurring during the 6-12th week of gestation. Normally, the intestines undergo evisceration, growth, return to the abdominal cavity with counterclockwise rotation and fixation. Malrotation is an error in rotation and fixation. Abnormal fixation and a narrow-based mesentery (blood supply to the intestines) predispose to twisting of the intestines on its blood supply. This causes intestinal obstruction and vascular compromise.

 

How is it diagnosed?

Typically, a previously healthy baby or child, without a history of surgery, will have bilious vomiting (emesis), maybe abdominal distention, lethargy and shock. If a child is acutely ill, no testing or studies are obtained, rather they are taken urgently to the operating room for exploration. If the diagnosis is in question, then an UGI is obtained to evaluate the intestinal anatomy.

What is the treatment?

Ladd’s Procedure: Exploratory laparotomy with evisceration of the intestines, lysis of Ladd’s bands, broaden the mesentery, appendectomy, and return the small intestines to the right and the large intestine to the left.

Hospital stay is 5-7 days. A post-operative ileus usually lasts for 3-5 days with a tube in the stomach until bowel function returns.

 

What is the expected outcome?

Excellent, with success rates greater than 95%. There is always the potential for a recurrent twist (volvulus), although this is very low.

 

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