Intestinal Malrotation

Malrotation is an obstruction caused by abnormal development of the intestines while a foetus is in the mother's womb.  In the United States it accounts for approximately 5% of all intestinal obstructions.  Some children with Malrotation have other congenital malformations like defects of the digestive system, heart defects and abnormalities of other organs, including the liver and spleen.  It is not known why the small and large intestines don't 'coil' properly during foetal development.

When a foetus is developing in the womb, the intestines start out as a small, straight tube between the stomach and the rectum. As this tube develops into separate organs, the intestines move for a time into the umbilical cord, which supplies nutrients to the developing embryo.  Around the tenth week of pregnancy, the intestine moves from the umbilical cord into the abdomen. It fits in by making two turns that allow it to lie in a specific position within the abdomen. When the intestine does not make these turns properly, Malrotation has occurred.

Some people who have Malrotation never experience complications and are never diagnosed.  Most children with this condition develop symptoms during infancy, often during the first month of life, and the majority are diagnosed by the time they reach 1 year of age. Although surgery is required to repair Malrotation, most children experience normal growth and development once the condition and any problems associated with it are treated and corrected.

Malrotation in itself may not cause any problems. However, obstruction caused by volvulus (when the intestine twists itself causing a lack of blood flow to the tissue and leading to tissue death) or Ladd bands (bands of tissue that have formed that obstruct the first part of the small intestine) are both life-threatening problems. The intestines can stop functioning and intestinal tissue can die from lack of blood supply if an obstruction isn't recognized and treated.

A large percentage of children with Malrotation are first diagnosed with Gastro-Oesophageal reflux, if symptoms persist children are often sent for barium radiology.  In a lot of cases with children over 3 months of age an anti-reflux operation and a Ladd's procedure are often necessary to stop Gastro-Oesophageal reflux when an intestinal Malrotation is present.

Links to other sites on this topic

kidshealth.org

www.ich.ucl.ac.uk