Edit concept Question Editor Create issue ticket

Intestinal Malrotation

Congenital Malrotations


Presentation

  • Although typically presenting as right lower-quadrant pain, in rare cases it may present as left upper-quadrant pain secondary to abnormal position due to intestinal malrotation.[ncbi.nlm.nih.gov]
  • The objective of this report is to describe the presentation of severe cases of midgut volvulus presenting in infancy, and to discuss the characteristics of these cases.[ncbi.nlm.nih.gov]
  • Clinical presentation, operative treatment, and outcome were recorded. Nine patients presented with obstructive symptoms (five chronic and four acute).[ncbi.nlm.nih.gov]
  • Clinical presentation, operative treatment, and outcome were recorded. RESULTS: Nine patients presented with obstructive symptoms (five chronic and four acute).[doi.org]
  • Infants nearly always presented with emesis (93%), whereas adults most commonly presented with abdominal pain (87%), and less often with emesis (37%) or nausea (31%).[ncbi.nlm.nih.gov]
Abdominal Pain
  • Clinicians should be aware of this rare but serious cause of abdominal pain.[ncbi.nlm.nih.gov]
  • BACKGROUND Appendicitis is the most common cause of abdominal pain requiring emergent surgical intervention.[ncbi.nlm.nih.gov]
  • Most often the diagnosis is established in the first year of life on the basis of abdominal pain and bile-stained vomiting secondary to bowel obstruction.[ncbi.nlm.nih.gov]
  • His abdominal pain has not recurred in 6 months of follow-up since the operation.[ncbi.nlm.nih.gov]
  • Although midgut volvulus is seen most frequently in infants, risk and complication rate are high beyond 1 year of age as well, and can manifest as failure to thrive, food intolerance, and abdominal pain needing recurrent hospitalization.[ncbi.nlm.nih.gov]
Bilious Vomiting
  • We herein describe a case of a 9-day-old female presented with a two-day history of bilious vomiting, feeding intolerance, weakness and lethargy. Preoperative studies were diagnostic of intestinal malrotation.[ncbi.nlm.nih.gov]
  • We suggest that such an antenatal finding should alert the paediatrician to close clinical follow-up and prompt the diagnosis and surgical treatment in case of abdominal pain and/or bilious vomiting.[ncbi.nlm.nih.gov]
  • We report the case of a 14-year-old male patient with bilious vomiting and abdominal distension. A diagnosis could not be made by computed tomography, ultrasonography, or endoscopy. We observed a dilated stomach and malrotation in laparotomy.[ncbi.nlm.nih.gov]
  • RESULTS: Bilious vomiting was the cardinal complaint in both groups.[ncbi.nlm.nih.gov]
  • He was breast-fed and received commercial cow's milk supplementation starting the day of birth and was admitted to our hospital at 6 days of age due to bilious vomiting. Plain abdominal radiography showed a paucity of gas in the distal bowel.[ncbi.nlm.nih.gov]
Constipation
  • Ultimately, three (two laparoscopic, one open) had persistent symptoms of bloating (n 2), constipation (n 2), and/or pain (n 1). CONCLUSION: Laparoscopic repair appears to be safe and effective in adults.[ncbi.nlm.nih.gov]
  • They can include: Vomiting green digestive fluid (bile) Drawing up the legs Stomach pain Swollen belly Diarrhea Constipation Rectal bleeding Failure to thrive Fast heart rate Fast breathing Bloody stools The symptoms of malrotation may look like other[urmc.rochester.edu]
  • Ultimately, 4 patients (2 laparoscopic, 2 open) had persistent symptoms: bloating (n 2), constipation (n 2), and/or pain (n 2). Table 1.[sages.org]
  • These can include: Pulling up legs and crying every 20-30 minutes due to the recurrent spasms Diarrhea or constipation Vomiting and inability to hold down solid food Failure to thrive (this means that the baby is not growing and gaining weight the way[healthstoriesforkids.com]
  • When the intestine becomes twisted or obstructed, the symptoms may include: Vomiting bile (green digestive fluid) Drawing up the legs Abdominal pain Swollen abdomen Diarrhea Constipation Rectal bleeding Failure to thrive Rapid heart rate Rapid breathing[choc.org]
Abdominal Distension
  • We report the case of a 14-year-old male patient with bilious vomiting and abdominal distension. A diagnosis could not be made by computed tomography, ultrasonography, or endoscopy. We observed a dilated stomach and malrotation in laparotomy.[ncbi.nlm.nih.gov]
  • The second case was a 76-year-old woman admitted with multiple fractures and increasing abdominal distension following a fall.[ncbi.nlm.nih.gov]
  • Surgery References: [1] [5] [12] [19] [22] [23] Intestinal malrotation and midgut volvulus Definition Clinical presentation Malrotation : mostly asymptomatic Midgut volvulus Features of duodenal obstruction: bilious vomiting without abdominal distension[amboss.com]
  • distension) · Pyloric stenosis (same age group, no bilious vomiting)[learningradiology.com]
  • Case presentation An 85-year old male presented with sudden onset central abdominal pain, progressive abdominal distension, diarrhoea, nausea and vomiting.[ncbi.nlm.nih.gov]
Periumbilical Pain
  • An 8-year-old boy with a history of recurrent abdominal pain presented with a 12 h history of severe periumbilical pain, nausea and vomiting. On examination, he was found to have a tender, erythematous, paraumbilical mass.[ncbi.nlm.nih.gov]
Irritability
  • Her medical history mentioned an Other Specified Feeding or Eating Disorder (OSFED), Irritable Bowel Disease (IBD) and lactose-intolerance. On physical examination she appeared hemodynamically stable, although cachectic with a BMI of 12kg/m2.[ntvg.nl]
  • […] crying every 20-30 minutes due to the recurrent spasms Diarrhea or constipation Vomiting and inability to hold down solid food Failure to thrive (this means that the baby is not growing and gaining weight the way it should) Stomach pain and swelling Irritability[healthstoriesforkids.com]
  • The patient described 1 year of self-limited episodes of abdominal pain that improved with defecation and were associated with a change in frequency and consistency of stools that were interpreted as irritable bowel syndrome.[acgcasereports.gi.org]
  • The abdomen was flat, flaccid, slightly painful on palpation of the epigastrium, but no signs of peritoneal irritation.[scielo.br]
  • They get diagnosed with Irritable Bowel Syndrome (IBS) and get sent home with a crazy concoction of IBS pharmacology. Surgeons don't like these referrals so much.[buckeyesurgeon.com]

Workup

  • Workup of these symptoms included computed tomography, which showed small-bowel dilatation along with a whirl sign and numerous collateral veins, suggestive of a midgut volvulus (see video ).[nejm.org]
  • Intestinal Malrotation: Differential Diagnoses & Workup[healthguideinfo.com]
  • In patients with chronic symptoms, workup includes a barium or CT /MRI abdomen. Imaging shows small bowel in the right and colon up and to the left [Figure 1] a.[journalofmas.com]
Colonic Stricture
  • CMV infection should always be excluded in full-term infants presenting with colonic stricture or malrotation.[ncbi.nlm.nih.gov]

Treatment

  • BACKGROUND: Intestinal malrotation in neonates or infants may require urgent surgical treatment, especially when volvulus and vascular compromise of the midgut are suspected.[ncbi.nlm.nih.gov]
  • Preoperatively, all patients underwent a period of conservative treatment.[ncbi.nlm.nih.gov]
  • Clinical presentation, operative treatment, and outcome were recorded. Nine patients presented with obstructive symptoms (five chronic and four acute).[ncbi.nlm.nih.gov]
  • Clinical presentation, operative treatment, and outcome were recorded. RESULTS: Nine patients presented with obstructive symptoms (five chronic and four acute).[doi.org]
  • A 73-year-old healthy male was referred to our foregut surgery service for treatment of severe biliary gastritis.[ncbi.nlm.nih.gov]

Prognosis

  • Exact incidence, prognosis and surgical implications related to ARM are unknown. The aim of this study was to identify relevant associations between ARM and the presence of malrotation.[ncbi.nlm.nih.gov]
  • Prognosis is directly related to the degree and duration of intestinal ischemia. Our goal is to describe our experience with TSIVM in the adult, to identify any specific findings and to discuss its management.[ncbi.nlm.nih.gov]
  • Further Reading Symptoms and Diagnosis of Intestinal Malrotation Symptoms and Diagnosis of Intestinal Malrotation Treatment and Prognosis for Intestinal Malrotation[news-medical.net]
  • Treatment and prognosis Due to the potential for life-threatening midgut volvulus and ischemic bowel, once discovered malrotation is corrected surgically.[radiopaedia.org]

Etiology

  • Although the pathogenesis of fetal primary small bowel volvulus is unclear, ganglion cell immaturity may play a role in the etiology.[ncbi.nlm.nih.gov]
  • There are four suggested etiological groups for GI malrotation: (i) abnormal L-R patterning, (ii) dorsal mesentery, (FOXF1) anomalies, (iii) irregularities of the intestine itself, and (iv) abnormalities of other abdominal contents.[news-medical.net]
  • Keywords: Adult, Case Report, Duodenum, abnormalities,Female, Human, Intestinal Obstruction, etiology,Pregnancy, Pregnancy Complications, etiology, How to cite this article: Hardikar J V. Malrotation of the gut manifested during pregnancy.[jpgmonline.com]
  • They are organised into groups, and further divided into clinical, etiological or histopathological sub-types.[orpha.net]

Epidemiology

  • Epidemiology of intestinal malrotation, Hawaii, 1986–99 First published: 04 April 2003 Cited by: 20 Summary Malrotation of the intestines occurs as a result of failure of normal intestinal rotation and fixation during early pregnancy.[onlinelibrary.wiley.com]
  • Epidemiology References: [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • EPIDEMIOLOGY Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut. Because rotational anomalies may remain asymptomatic throughout a person’s life span, the true incidence is not known.[uptodate.com]
  • Epidemiology In the United States, for example, asymptomatic GI malrotation occurs with an incidence somewhere between 1 in 200 to 1 in 500.[news-medical.net]
Sex distribution
Age distribution

Pathophysiology

  • To better understand the pathophysiology of Intestinal Malrotation, it is imperative to understand the anatomy of the abdomen, especially the position of the intestines, under normal circumstances.[epainassist.com]
  • Risk factors for the development of a volvulus References: [2] [3] [4] [5] [12] [13] [14] [15] [16] Pathophysiology Sigmoid volvulus Initial resuscitation : IV fluids ; acid-base and electrolyte imbalance correction ; n il per oral ; placement of a nasogastric[amboss.com]
  • Pathophysiology GI malrotation, has been recently suggested to result from genetic mutations. The gene implicated is the fork head transcription factor (FOXF1) gene.[news-medical.net]
  • His surgical approach, now known as the Ladd procedure, remains the cornerstone of practice today. [5] Pathophysiology Intestinal malrotation occurs due to disruption of the normal embryologic development of the bowel.[emedicine.com]

Prevention

  • The patient underwent a preventative Ladd's procedure and vaginal reconstruction.[ncbi.nlm.nih.gov]
  • Underlying incomplete malrotation prevented the correct clinical diagnosis of ruptured appendicitis.[ncbi.nlm.nih.gov]
  • BACKGROUND Bowel obstruction is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Intestinal malrotation is one of the rarest causes of mechanical bowel obstruction.[ncbi.nlm.nih.gov]
  • […] dehydration and antibiotics to prevent infection.[luriechildrens.org]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!