Malrotation is a disorder characterized by abnormal formation of the intestine in the abdomen. It usually occurs during the tenth week of gestation and, in affected babies, the intestine does not coil into the right position. One in 500 babies born in the US have malrotation, with symptoms occurring in the first 12 months of life.
When the fetus is developing, their intestines start as a small, straight tube. In the initial stage of pregnancy, the intestines begin to grow longer. As part of their growth, they turn inside the abdomen until they attain the right position. Once they are in the right position, they attach to the abdomen. However, in babies suffering from malrotation, the intestines do not turn or attach to the abdomen in the normal manner. They get twisted, and in the process, they create a blockage in a portion of the abdomen. The twisted portion does not get its blood supply resulting in death of that portion. This interferes with digestion of food in the baby.
Symptoms of Malrotation
Most children with malrotation start showing symptoms before they are 1 year old, though some children have symptoms later on and some are asymptomatic their whole life. Symptoms occur when a segment of the intestine gets blocked, which is called a volvulus.
Yellow or green vomit is the most common and early symptom. It is also known as bilious as it has bile, a liquid produced by the liver.
Babies with malrotation or volvulus usually show the following symptoms:
- Abdominal cramps caused when the bowel tries to push food past the blocked portion
- Being fussy or crying intermittently
- Sluggishness, tiredness, and lethargy
- Poor appetite
- Irregular, bloody, or no stools; diarrhea
- Painful and swollen belly
- High heart rate and rapid breathing
- Pale color
- High temperature and looking sick
- Drawing up the legs to cope with pain and cramps
Children with malrotation who do not experience any symptoms may only be diagnosed by accident during a surgery or X-ray for some other reason later in life.
Children with symptoms need to be seen by a doctor, who collects a detailed medical history of the child and performs a thorough physical exam.
Once the physical exam is over, the doctor orders imaging tests such as X-ray that show if and where the intestine is twisted or blocked.
The child is given a liquid before the X-ray test and the liquid is tracked as it passes through the child’s body to find the volvulus.
Upper GI Test
This is a procedure performed to examine the intestine for abnormalities. Barium - a metallic, chalky liquid - is inserted into the intestine to coat the internal organs, which allow better visualization on X-ray. The X-ray might reveal the abnormal position of the intestine or any blockage in it.
CT (also called CAT i.e., computerized axial tomography) uses X-rays and computers to produce several images of a body part from many different angles. These images provide an accurate visualization of the body part. In children with malrotation, a CT scan is performed to detect twisting or blockage in the intestine. A harmless or inert dye is usually injected into the intestine to view the blockage more easily.
Reviewed by Afsaneh Khetrapal BSc (Hons)