Malrotation in children should be treated as an emergency. This is because volvulus is usually life-threatening in nature and immediate surgery is the only solution.
Surgery to Fix the Intestines
In this surgery, a nasogastric tube is inserted through the nose of the child into the stomach so as to empty the contents of the stomach. IV (intravenous) fluids are given to the child to prevent dehydration in addition to other nutrients and antibiotics to help fight infection. Right before the surgery, the child is given general anesthesia.
To begin with, a small incision is made above the belly button and the intestines are taken out and untwisted by the surgeon. The surgeon makes sure the intestines look healthy and have a pink color to indicate adequate blood supply. Then the intestines are folded – the small intestine is attached to the right side of the abdomen and the large intestine is attached to the left side of the abdomen. They are placed in a way that minimizes the chances of twisting in the future.
The appendix is usually removed during this surgery as the new position of the intestines might make it hard to diagnose problems such as appendicitis. Finally, the incision is closed. In case blood flow does not improve, another surgery will be needed within a day or two to check the intestine. If a part of the intestine is damaged or looks unhealthy, it is removed.
In some children, a large part of the intestine is damaged and need to be removed. In such cases, the remaining portion of the intestine may not be lengthy enough to be attached together. Hence surgeons perform a procedure called ostomy in which the two ends are moved via small openings in the abdomen. This is a temporary arrangement where stool passes through the stoma or opening and is collected in a bag. Once the child fully recovers, this opening can be closed.
Approximately an hour after surgery, the child is moved to a hospital room. Children who are very ill are shifted to the intensive care unit (ICU) or neonatal ICU and then to the room whenever they are ready. Children who underwent surgery for malrotation usually stay in hospital for about a week depending on the rate at which their intestine recovers from the operation.
The child will need to get fed through an IV line for a few days after surgery. This is because the intestine needs to rest for sometime before they start to work again. When the intestines start functioning, the child will pass gas and doctors will then recommend normal feeding to start.
The surgeon will be in constant contact with the child and family during the entire duration of hospital stay. Once the child is discharged and goes home, a follow-up visit is scheduled 2-3 weeks post surgery to make sure the intestine is working properly and the surgical wound is healing.
Most children affected by malrotation and the resulting intestinal block can be successfully treated without much long-term issues if the block is fixed and there is no damage to the intestine. Children whose intestine is damaged and have the injured part removed are more at risk of long-term complications.
Removal of a portion of the intestine affects the digestive process in the child and prevent ingestion of adequate levels of fluids and nutrients. These children might need to be fed by way of IV supplementation.
Reviewed by Afsaneh Khetrapal BSc (Hons)