What is malrotation in children?
Malrotation is a congenital (present at birth) condition that affects the positioning of a baby’s small and large intestines within their abdomen. The intestines form early in fetal development. As part of that process, the intestines coil and rotate until they reach the proper position and attach to the abdominal wall. But in some cases, they don’t coil and rotate properly. This is called intestinal malrotation.
Most children will need surgery to fix the positioning of their intestines, prevent complications and help the digestive system work as it should.
What is Volvulus?
Volvulus is abnormal twisting of the intestines that compromises the blood supply to your child’s bowel. It’s the main complication of malrotation.
Volvulus happens because your baby’s intestines aren’t attached to the abdominal wall in the correct spots. Without proper anchoring, the intestines may start to twist in ways they shouldn’t. This twisting can prevent digested food from passing through the intestines and even restrict blood flow.
Picture a garden hose that twists in a loop and develops a kink. Water can’t pass through until you reposition the hose. With volvulus, the consequences can be much more serious.
Signs and symptoms usually appear in children before age 5 — often as early as the first month after they’re born — and include sudden vomiting (usually greenish in color) and bloating.
Volvulus is a surgical emergency. Untreated volvulus can lead to life-threatening complications, including:
- Bowel obstruction
- Bowel perforation
- Peritonitis
- Sepsis
- Shock
Signs of malrotation in infants
Signs and symptoms of malrotation in infants include:
- Frequent vomiting, which may be green or yellow-green due to the presence of bile.
- Abdomen that’s swollen, painful or tender to the touch.
- Severe abdominal colic pain.
- Rectal bleeding or bloody poop.
Babies with cramps and pain from malrotation frequently follow a typical pattern. They’ll:
- Draw their legs up and cry.
- Settle for about 10 to 15 minutes.
- Begin to cry again.
Signs of malrotation in children over age 1
Signs and symptoms in children over age 1 include:
- Abdominal pain or tenderness.
- Nausea and vomiting.
- Diarrhea.
- Bloated belly.
- Constipation.
- Rectal bleeding or poop that contains blood.
- Not growing as expected.
Some research shows that kids over age 2 are less likely to produce green vomit than infants. Older children typically have recurrent vomiting (normal in color) and abdominal pain.
Management and Treatment
Babies and children with malrotation typically need surgery to realign their intestines.
Senior Pediatric Surgeon in Lucknow, Dr. Ajay Kumar Verma, through a minimally invasive surgery technique will untwist your child’s intestines and reposition them within their abdomen.
There are two main surgeries that we use to manage malrotation:
- Ladd’s procedure. Ladd’s procedure involves releasing abnormal bands of tissue that prevent the intestines from working as they should. We will also adjust how your child’s intestines are rotated and positioned. We can perform Ladd’s procedure via open surgery or laparoscopic methods. Although Ladd’s procedure helps ease symptoms, it’s possible for a child’s intestines to abnormally twist again in the future (recurrent volvulus).
- Kareem’s procedure. This involves rotating the intestines all the way to their proper position and connecting them to the abdominal wall. This technique may lower the risk of recurrent volvulus.
We will discuss the best approach to use in your child’s situation. along with the benefits and risks. Depending on the anatomy and health of their intestines, your child may also need:
- A temporary or permanent colostomy.
- A portion of their intestines removed.
- Intestinal reconstruction.
- Their appendix removed.
Don’t hesitate to ask us questions. We’ll help you understand more about what’s happening and what your child’s recovery will look like.