Intestinal malrotation is a congenital disorder that occurs when the baby is in the womb. It means the intestines are not in the correct position. It occurs during the development stage of the baby. Normally during the fourth week of gestation, the intestine starts to grow. Initial growth is like a short tube which herniates into the umbilical cord and in the amniotic fluid where there is more space. At tenth week of gestation the intestine re-enters into the abdomen and makes two physiological turns.
However, when there is lack of this physiological turn, it results in a disorder that we label as intestinal malrotation.Approximately out of all births, intestinal malrotation occurs in 0.2%. The symptoms may develop in early weeks of life or may sometimes develop after one year. Complications include volvulus and intestinal obstruction. Both are fairly serious complications. Intestinal malrotation when detected needs surgery to put the intestine in their correct place.
What Causes Intestinal Malrotation?
The exact cause of intestinal malrotation is not known. There is not association of any genetic abnormality, but patient with malrotation may have history of this disorder in his family in some cases. Normally during the fourth week of development, intestine begins to develop.It grows in size as a long elongated tube. To grow in size it herniates outside the abdomen into the umbilical cord for few weeks.
Once the fetus reaches 10 weeks, the intestine re-enters into the abdomen. During this process it rotates twice normally so that it does not remain as a straight tube. When this rotation does not occur, it leads to a disorder called malrotation. Almost 1 in 500 babies in USA have intestinal malrotation.
It may or may not produce any symptoms. But sometimes there is a risk of developing obstruction and sharp twist of intestine called volvulus. Malrotation occurs equally in boys and girls, but the symptoms develop more in boys during the first month.
Signs And Symptoms Of Intestinal Malrotation
Most children with malrotation of intestine start to develop symptoms before the age of one year. Some children develop symptoms in later years while in some people symptoms may not manifest throughout life. Symptoms develop when a part of intestine gets obstructed or twists awkwardly. Most prominent symptom is yellow or green colored vomiting. It is bilious vomiting which consists of bile produced by liver.
Following are the signs and symptoms noted in babies having intestinal malrotation associated with obstruction or volvulus:
- Mild or severe abdominal cramps in abdomen when the bowel tries to push the food forward in the intestine.
- Crying and irritable
- Poor appetite
- Sluggish and lethargy
- Blood and sticky stool like jelly.
- Distension of abdomen.
- The child becomes pale.
- Rapid heart rate
- Frequently pulls and folds leg towards abdomen because of cramps.
Diagnosis And Treatment Of Intestinal Malrotation
Child with intestinal malrotation who does not have any symptoms may not be diagnosed of the condition. The condition may be detected accidentally only when X-ray or CT scan of abdomen is performed for some other reason. Diagnosis is made when the child has symptoms. A detailed medical examination and history along with tests such as X-ray of abdomen, CT scan of abdomen, X-ray barium, etc will reveal the suspected malformation.
Malrotation of intestine causes obstruction and twisting of the intestine. Both may be life threatening if they occur. Early detection from the symptoms will help to treat the condition without causing more damage. Surgery is the treatment choice in this disorder. During surgery, the malrotation is corrected and abnormal bands and tissues attached to the intestine are removed. The surgical technique applied is called Ladd’s procedure.