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What is Malrotation?

Malrotation is a rare prenatal abnormality in which a baby’s intestine doesn’t form or rotate in the right way in their abdomen. It occurs early in pregnancy (around the 10th week) and develops when a baby’s intestine fails to coil into the proper position. This means that parts of the intestines are in the wrong location.

Malrotation can be asymptomatic (have no symptoms), and isn’t often evident unless a baby experiences an abnormal twisting of the intestine known as a volvulus. A volvulus causes an obstruction or blockage in the intestine, preventing food from being digested normally.

How Common Is Malrotation?

Malrotation occurs equally in boys and girls. However, more boys show symptoms within the first month of life than girls. Malrotation may also be associated with other birth or intestinal defects.

What Are The Symptoms of Malrotation?

One of the earliest signs of malrotation is abdominal pain and cramping caused by the inability of the bowel to push food past the obstruction. Babies with cramps and pain due to malrotation frequently follow a typical pattern: they may draw their legs up and cry, settle for about 10 to 15 minutes and then begin to cry again. If your baby follows this pattern or experiences any of the following symptoms call your pediatrician right away.

  • Frequent vomiting, often green or yellow-green in color.
  • A swollen, firm abdomen.
  • Pale color.
  • Poor appetite.
  • Little or no urine (due to fluid loss).
  • Infrequent bowel movements.
  • Blood in the stools.
  • Fever.
  • Lethargy (showing little energy).

How is Malrotation Diagnosed?

After performing a thorough physical exam of your baby, your pediatrician will order tests that evaluate the position of the intestine, and show whether it’s twisted or blocked. These tests may include:

  • Abdominal X-ray: an X-ray that may show intestinal obstructions.
  • Barium enema X-ray: Barium is a liquid that makes the intestine show up more clearly on the X-ray. For this test, barium is inserted into the intestine through the anus and then X-rays are taken.
  • CT scan: CAT or CT (computerized axial tomography) scan uses computers and X-rays to produce many pictures from multiple angles to give doctors an accurate picture of the body. In the case of possible malrotation, a CT scan looks for a blockage in one of the intestines. To help do this, a harmless dye is injected so that the blockage is more easily seen.

How is Malrotation Treated?

Malrotation is considered an emergency situation and the development of volvulus is considered a life-threatening condition. Surgery is required to fix the problem.

  • Your baby will be started on IV (intravenous) fluids to prevent dehydration. Your baby will receive antibiotics to prevent infection, and sedation so your baby sleeps through the procedure.
  • First, the surgeon untwists the baby’s intestine and checks it for damage. If the intestine is healthy, it’s then replaced in the abdomen.
  • If the blood supply to the intestine is in question, the intestine may be untwisted and placed back into the abdomen.
  • Your surgeon performs another operation within 24 to 48 hours to check the health of your baby’s intestine. If it appears that the intestine has been damaged, the injured section may be removed.

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