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Pediatric Intestinal Malrotation and Volvulus

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Summary

During fetal development, the bowels develop and grow outside the abdomen through an enlarged opening at the base of the umbilical cord.  Over time, the intestines slowly retract into the abdomen and become fixed in the usual position through a process called rotation. 

Expanded overview

If the intestines don’t rotate back into the abdomen properly (i.e. malrotation) the baby is at risk for a delayed and unpredictable twisting of the bowels (volvulus), intestinal obstruction and intestine damage.  In its worst form, a volvulus can stop oxygen from getting to the intestine and the intestine may die. Volvulus is considered a medical emergency and can be fatal if not immediately treated. 

Causes

Volvulus is most often caused by malrotation of the intestines during fetal development. Your child may be born with intestines that did not rotate into the correct position in the abdomen during development.

In some cases, there is no known cause for volvulus.

Risk factors

A child born with the birth defect that causes intestinal malrotation is more likely to develop a volvulus.

Symptoms

When a child is born with malrotation of the intestines, there may be no signs at first. Later, usually during the first year of life, the malrotation causes volvulus — and the intestines become blocked or twisted. If your child has volvulus, they will develop sudden, severe symptoms, including:

Treatment

To prevent a volvulus in a baby with intestinal malrotation, we perform an operation called Ladd’s Procedure.  A Ladd’s operation places the intestine in a position that is much less likely to twist or become obstructed.

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