Malrotation

Malrotation

presentation
1. obstruction
  1. w/ bilious vomiting
    1. usual presentation in 1st few days of life
      1. can also be seen at later ages
    2. child needs urgent upper GI contrast study
      1. to assess intestinal rotation
      2. contraind if signs of vascular compromise present
        urgent laparotomy
2. obstruction with a compromised blood supply
3. abdominal pain
4. tenderness from peritonitis or ischaemic bowel
during rotation of small bowel in fetal life
1. if mesentery not fixed at duodenojejunal flexure or in ileocaecal region
  1. base of mesentery is shorter than normal
predisposes to volvulus
Rx
1. surgical correction
  1. volvulus untwisted
    1. duodenum mobilised
      1. bowel placed in non-rotated position w/ duodenojejunal flexure on the right & caecum and appendix on the left
  2. malrotation is not 'corrected'
    1. but mesentery is broadened
  3. appendix generally removed
    1. to avoid diag confusion if child subseq has sx suggestive of appendicitis

Resource summary

	Created by v.djabatey almost 11 years ago