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While a baby is still in the womb, its intestines (bowels) form. As they form, they move into their normal position in the abdomen (belly). Intestinal malrotation happens when the intestines don’t form in the right position. The intestines may bend the wrong way. Or, parts of the intestine may end up in the wrong part of the abdomen. Bands of tissue called Ladd bands can grow between the intestines and body wall. These secure the intestines in the wrong place. Ladd bands can also block part of the intestine, causing digestive problems.
Intestinal malrotation most often isn’t a problem by itself. But it makes a child more likely to have a volvulus (twisted intestine). A volvulus can be very dangerous. That’s why intestinal malrotation needs to be treated, even if your child has no symptoms.
When symptoms occur, they often happen during a child’s first year. But in many cases, intestinal malrotation causes no symptoms. If symptoms do occur, they can include:
Vomiting, sometimes green-tinged (a sign of bile in the vomit).
Severe abdominal pain, either sudden or ongoing. A baby may express this pain by crying inconsolably.
Acid reflux (fluid that travels up from the stomach and out the mouth).
If the child has symptoms, diagnosis starts with a health history and physical exam. These help the doctor narrow down the cause of the symptoms. Tests may then be done to confirm the problem. If the child has no symptoms, intestinal malrotation may be discovered during a test for another health problem. Tests that can detect intestinal malrotation include:
Abdominal ultrasound: Sound waves are used to create an image of the inside of the abdomen.
Upper GI series: X-rays are taken of the upper digestive tract from the mouth to the small intestine. During the upper GI series, the child swallows a chalky fluid containing barium. This liquid coats the insides of the upper digestive organs. The barium causes these organs to show up on an x-ray.
Barium enema: Barium is inserted through the anus into the rectum. It coats the inside of the lower digestive organs so they show up on an x-ray.
If the child has only intestinal malrotation, surgery is done. During surgery, any Ladd bands present are cut. The intestines are then moved to where they will be least likely to twist. The intestines may then be attached to the abdominal wall to keep them from moving in the future. If the child still has his or her appendix, it will be removed during the surgery.
If the child has intestinal malrotation with a volvulus, surgery is done right away. The intestine is carefully untwisted. If a portion of intestine has died due to lack of blood flow, this portion must be removed. The healthy ends of the intestine are then reattached. If a long length of intestine is removed, a small opening (stoma) may need to be made in the child’s abdomen. This provides a new way for waste to leave the body. If your child needs a stoma, the doctor will tell you more.
Most children have good outcomes. Watch the child for signs and symptoms of volvulus in the future, including stomach pain and swelling, vomiting, or inability to pass stool. Volvulus can cause severe damage or even death. If the child has a volvulus, the outcome depends on how damaged the intestine is and how much needs to be removed.