What is Malrotation? What are the Symptoms of Malrotation?

The intestine is a crucial organ of the digestive system. It is a long, continuous tube from the stomach to the anus. The organ develops in the fetus during the 10th week of pregnancy. Malrotation develops when the intestine fails to coil into the proper position in the abdomen.

About Malrotation

Malrotation is often revealed when the baby has  a twisting of the intestine , known as volvulus. There is difficulty in digestion of foods and intestinal obstruction.

Sometimes, the intestine may become injured due to the restriction or stoppage of blood supply. Here, a part of the intestine may even die due to the prolonged absence of blood supply. Doctors recommend immediate surgery to prevent fatality and rectify the condition. After the procedure, most kids grow perfectly and lead a normal life.

What are the Symptoms of Intestinal Malrotation?

Since malrotation causes significant discomfort in babies, parents notice abdominal pain and cramping as its earliest signs. Babies find it challenging to push the food across the intestine due to the twisting or obstruction. You may see a typical pattern in the crying of babies during the discomfort. The infant tends to pull his or her legs in the upward direction. He or she then becomes silent for about 10 or 15 minutes and then restarts crying. The baby seems to repeat this pattern frequently.

Other associated symptoms of malrotation include:

• Frequent vomiting (the baby ejects greenish-yellow digestive fluid along with the vomit)
• Poor appetite
• A swollen and firm abdomen
• Abdominal distention
• Pain in the abdomen
• Infrequent bowel movements
• Pale colored body
• Insufficient urine [due to dehydration]
• Fever
• Rapid heart rate
• Stunted growth
• Blood in the stools

When to See a Doctor

As intestinal malrotation is a life-threatening condition,  if  you notice the signs and symptoms of this congenital disorder in your baby,  do not waste any time in booking an appointment with a pediatrician for further investigations. It will help in the correct diagnosis and immediate treatment measures.

Request an appointment at Apollo Hospitals

Call 1860-500-1066 to book an appointment

What are the Causes of Intestinal Malrotation?

Human beings have a 20-feet long small intestine and a 5-feet long large intestine coiled in the abdomen. In the fetus, the intestine starts developing in the early stage of pregnancy. During the 8th to 10th week of gestation, a small straight tube develops in the fetus. It is the precursor of the intestine.

As the fetus develops, the tube grows and stretches between the stomach and the rectum. However, the space in the baby’s abdominal region is too small to allocate space to the intestinal tube. So, the loops of the intestine bulge into the umbilical cord. It helps in obtaining nutrition for the growing fetus.

During the end of the first trimester, the intestine again fits into the abdomen by making several rotations. If the intestinal tube fails to coil perfectly, then it creates malrotation. However, the exact reason behind the fetus’s intestine’s incomplete folding is still elusive. Babies born with this congenital deformity also risk developing other disorders, like defects in the digestive system, heart ailments, and anomalies in the liver or spleen.

Who are at Risk for Intestinal Malrotation?

Though malrotation can occur equally in male and female babies, boys demonstrate the symptoms during the first month of life in the majority of cases.

How is intestinal malrotation diagnosed ?

1. Abdominal X-ray: It is an X-ray which can show intestinal obstructions
2. CT scan:  In case of possible malrotation, doctors may use a CT scan to check for a blockage in one of the intestines.
3. Barium enema X-ray: Barium is a liquid which makes the intestine visisble better on the X-ray. For Barium enema X-ray test, barium is inserted into the intestine through the anus and then X-rays are taken.

How do Doctors Treat Intestinal Malrotation?

Malrotation can be a life-threatening condition. So, doctors often conduct emergency surgery to save the life of the patient. Have a look at the various treatment measures for this disorder.

Abdominal surgery

If malrotation remains associated with a volvulus (twisting of the intestine), abdominal surgery can rectify it. Surgeons make a cut or incision in the lower abdomen to examine the bowel. They untwist the affected part and restore the blood supply. The child requires IV (intravenous) fluids and antibiotics during the procedure to prevent dehydration and secondary infection.

Colostomy

Sometimes, a small portion of the intestine may die due to the prolonged absence of blood supply. When this happens, the remaining parts of your intestine may not be able to get attached with each other surgically. A colostomy is done to correct this in order to enable the digestive process to continue. With a colostomy, the remaining two healthy ends of the intestine are brought through openings in your abdomen. Stool will pass through an opening called stoma and then into the collection bag. The colostomy can be temporary or permanent, depending on the amount of intestine that is needed to be removed.

What are the Complications of Intestinal Malrotation?

You should seek medical help immediately if your baby gets detected with intestinal malrotation. Leaving it untreated for a prolonged period can be life-threatening. The complications of this disorder include.

Volvulus

The malfunctioning intestine is prone to twisting on itself inside the baby’s abdomen. It can even cut off the blood supply to the tissue and lead to the premature death of the affected tissue. If it remains restricted to a small intestine area, the condition is known as midgut volvulus. Babies undergo extreme pain and cramping in this complication.

Ladd’s bands

In some cases, babies develop bands of tissue in the duodenum (the initial part of the small intestine). These bands are known as Ladd’s bands. They can obstruct the bowel movement and cause pain.

The development of volvulus or Ladd’s bands in the intestine can be a potential life risk. You should immediately take  your child to a hospital for immediate medical attention. In many cases, the patient requires emergency surgery to retain the functionality of the intestine.

Conclusion

Malrotation is a congenital deformity due to the fetus’s faulty coiling of the intestine. Though it develops in the first trimester of pregnancy, the condition becomes evident when the intestine becomes twisted on itself  and causes an obstruction.

Frequently Asked Questions (FAQs)

1. What are the Diagnostic Tests for Malrotation?

Doctors can diagnose malrotation in children by  the symptoms and physical examination. They also prescribe an Abdominal X-ray, Barium swallow upper GI test, Barium enema, ultrasound examination, and CT scan to obtain a detailed picture of the intestine. These imaging tests help in deciding the future course of treatment.

2. What Happens During a Barium Swallow Upper GI Test?

The barium swallow upper GI test helps detect the intestine abnormalities and determine the jejunum’s exact position in malrotation. Here the doctor offers a chalky barium fluid to the child to swallow. If the baby cannot swallow it, the doctor places the fluid in the stomach through a small nasogastric tube—the compound coats the stomach and intestine to obtain a clear picture of the X-ray.

3. How Long Does the Child Empty the Stool in a Bag in an Ileostomy?

Surgeons perform an ileostomy in malrotation patients for quick healing of the affected intestine. Here, doctors bring the intestine’s cut end to the abdomen through a small opening called a stoma. It allows the stool to empty into a bag. After the intestine heals, doctors perform another surgery to remove the colostomy and reconnect the intestine , making it function normally.