Malrotation of the Bowel
Overview
The digestive system processes and uses the nutrients in food and drink. The intestines (bowel) are a part of the digestive system that runs from the mouth to the anus. If you spread out the intestines end-to-end, they would stretch several feet long. In the body, the intestines are folded tightly and take up only part of the abdomen.
Malrotation of the bowel occurs when a baby is born with the intestines in the wrong location within the abdomen. In a typical baby, the intestines go through a rotation while developing in the uterus. In a baby with malrotation of the bowel, the intestines did not properly undergo rotation. If the intestines are not properly rotated, this puts the baby at risk for developing a blockage in the intestine. This is because the malrotation does not allow food and drink to pass through normally, and the blood supply to the bowel may become damaged.
Symptoms of Malrotation of the Bowel
Some babies and children with malrotation of the bowel won’t experience symptoms, and the condition may never be diagnosed. However, most children will have symptoms and receive a diagnosis before age 1. Symptoms of this condition may include:
Abdominal pain
Blood in the stool
Drawing up the legs
Rapid breathing
Rapid heartbeat
Slow growth, or failure to thrive
Swelling of the abdomen
Vomiting bile (yellow-green digestive fluid)
When to see a doctor
Take your child to see a pediatrician (doctor who specializes in treating children) right away or go to the nearest emergency room if they experience any of the above symptoms.
Causes of Malrotation of the Bowel
Twisted intestines are a congenital (present at birth) condition. During the baby’s development inside their mother’s womb, the intestines do not twist into the proper location. Experts do not know why this happens.
Who’s at risk
Malrotation of the bowel occurs in about 1 in every 500 babies born in the United States. There are no known risk factors for being born with twisted intestines. However, babies with this condition also often have other problems present at birth that may affect the:
Abdominal wall
Digestive system
Heart
Liver
Spleen (organ filtering the blood)
Diagnosis of Malrotation of the Bowel
Although this condition can affect children of any age, nearly 90% of children with malrotation of the bowel are diagnosed before age 1, and many of those will be diagnosed in the first week of life. Your child’s pediatrician (doctor who specializes in treating children) will complete a comprehensive physical exam to begin diagnosing this condition. This exam will include asking questions about your child’s personal and family medical history. From there, your child will take one or more of the following tests to confirm malrotation of the bowel:
X-ray. This common imaging test captures detailed pictures of the inside of your child’s body.
Ultrasound. This test uses sound waves to capture detailed images of the inside of your child’s body.
Upper gastrointestinal (GI) test. This test involves your child swallowing barium (a silver-colored liquid) to help the doctor identify issues. During the test, your child’s doctor captures detailed images of the small intestine.
Barium enema. This test involves delivering barium (a silver-colored liquid) directly into the rectum. Barium shows up well as a contrast to your body’s tissue on X-rays. During this test, your child’s doctor captures detailed images of the bowels.
Treatments for Malrotation of the Bowel
If your child’s pediatrician diagnoses malrotation of the bowel, your child will need surgery to correct the twisting. Your child will likely receive fluids and medicine in their veins via an intravenous (IV) line before surgery. They may also have a nasogastric (NG) tube running from the nose to the stomach to prevent gas buildup in the stomach.
In most cases, your child’s surgeon will use minimally invasive surgery techniques to correct the twisting of the intestines. These methods mean smaller incisions (cuts), less blood loss, and a shorter recovery time. For the surgery, your child will be under general anesthesia (fully asleep).
To begin, the surgeon will make small incisions (cuts) in your child’s abdomen. The surgeon will insert a tiny surgical camera into one incision and thin surgical tools into the others. The surgeon will fill your child’s belly with gas to expand the area and make it easier to see inside.
During the surgery, a monitor from the surgical camera will display the inside of your child’s abdomen. The surgeon will use the surgical tools to correct the unusual twisting. They may also remove your child’s appendix at this time. Then, the surgeon will close the incisions with stitches and bandages.
Your child will spend several hours in a recovery area. The care team will carefully monitor them as they wake up from the anesthesia. Your child will receive intravenous (IV) fluids (fluids through a vein) to prevent dehydration.
Your child will spend a few days in the hospital following the surgery. During this time, they may receive medicines to reduce the risk of infection or manage any pain. Your child may need a tube that goes from nose to stomach to help relieve gas and fluids that build up. This will need to be removed before they can begin eating. Once they are showing improvement and the surgeon has cleared them, your child will be able to drink clear liquids and later eat solid foods. Once they are cleared to begin a regular diet again, your child’s care team will work with you while your child is in the hospital so you understand your child’s dietary requirements.
Home remedies
In most cases, the long-term outlook for children who undergo surgery to correct malrotation of the bowel surgery is very good. In some cases, children with this condition may have trouble absorbing fluids and nutrients from their food and will need to receive supplemental nutrition. This supplemental nutrition is called total parenteral nutrition – or TPN – and is delivered through a vein (intravenous) so that it bypasses the intestine. Your child’s surgeon will provide you with specific instructions based on your child’s unique needs and situation.
Contact Us
If you suspect that your child may have Malrotation of the Bowel, make an appointment with an Orlando Health pediatrician today so your child can start on the road to improved health.
