Malrotation with Volvulus
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image by: Keeras Malrotation
HWN Suggests
Malrotation
Consider Malrotation in patients with vomiting with or WITHOUT abdominal distension...
Presentation of Malrotation
- The Neonate (<30 days of age)
- Most malrotation present in this population.
- ~50% will present in first week of life and more than 60% before the end of the 1st month.
- Bilious emesis is the most frequent symptom (but not the sine qua non).
- Pain and irritability are not prominent clinical features in the neonate!
- Abdomen is soft and not tender (until there is strangulation).
The older child
- 20% develop symptoms after…
Resources
Intestinal Malrotation Foundation
The Intestinal Malrotation Foundation was created to provide education, advocacy, resources and support to families impacted by intestinal malrotation and it's complications, including volvulus, short bowel syndrome and chronic motility issues.
Isabelle's Intestinal Malrotation Story
At age four our daughter Isabelle had abdominal surgery for intestinal malrotation. In some ways we were blindsided by it, but deep down it was no surprise.
Abdominal pain with a twist
Malrotation in children is due to either an incomplete or non-rotation of the foetal mid-gut during perinatal development. Presentation is usually in the first few weeks of life, often with life-threatening volvulus and ischaemia. However, it can be a rare cause of abdominal pain in older children and young adults.
Defusing the intra-abdominal ticking bomb: intestinal malrotation in children Ihab M. Kamal
Neonates with intestinal malrotation present with bilious (green) vomiting caused by duodenal obstruction by congenital bands or midgut volvulus. Beyond the neonatal period, however, the clinical presentation of malrotation is variable and not as well defined.
Midgut Volvulus: The Whirlpool and Corkscrew Signs
Midgut volvulus is a life-threatening condition that usually occurs in neonates and young infants. If not promptly addressed, it may result in short bowel syndrome with lifelong dependence on total parenteral nutrition or even death. Bile-stained emesis is the characteristic presenting symptom requiring emergent imaging investigation.
The Pediatric Surgical Abdomen
Bilious vomiting (80-100%) in the 1st month; especially in the 1st week.
The vomiting infant: When should intestinal volvulus be suspected?
Intestinal malrotation is a predisposing factor for volvulus and bowel obstruction in infancy and childhood. It is due to defects in intestinal rotation that occur during embryonic and foetal development. The different types of intestinal malrotation are classified based on the stage of development at which the defect occurs.
Malrotation
The Neonate (<30 days of age) - Most malrotation present in this population.
Core EM
Depending on the progression of the strangulation an abdominal X-ray will show evidence of small bowel obstruction or lack of any gas in the abdomen. Free air may be seen due to ischemic bowel perforation.
Nationwide Children's
Most children with this condition have symptoms within the first year of life. Some people who have malrotation go their whole lives without having any symptoms and are never diagnosed. Other people may not have symptoms until adolescence or adulthood.
NIDDK
Experts are not sure how common malrotation is because not all people with malrotation develop signs or symptoms. Some studies suggest that about 1 in 500 people have malrotation.
StatPearls
Midgut volvulus can happen at any age, but most commonly occurs during the first few weeks of life. Bilious emesis is usually the first feature of volvulus. Infants that present with sudden-onset bilious vomiting, upper abdominal distension, and abdominal tenderness associated with hemodynamic deterioration must be rapidly evaluated to ensure that they do not have intestinal malrotation along with volvulus.
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