9.4 Malrotation, Volvulus, Intussusception

Question 1

Malrotation

Answer 1

• Congenital defect that occurs during gestation where bowel does not take normal shape (normal rotation of bowel and bowel loops does not happen properly),
• Stomach tube starts out straight then at 10 weeks bowel should take its normal shape.
• Ladd band’s normally attach to cecum to RLQ but in Malrotation there is just loose and hanging bowel that is not attached to anything.
• This leads to volvulus (twisting of bowel) which can lead to obstruction, necrosis, ischemia, peritonitis, perforation, death. MEDICAL EMERGENCY.

Question 2

Intussusception

Answer 2

• Telescoping of one portion of the intestines into another.
• Commonly seen in ileocecal valve
• Invagination (telescoping) causes obstruction of flow intestinal contents

S/S
- Edema and inflammation which decreases blood flow which can cause ischemia, perforation, peritonitis, shock and death.

• Abdominal pain
• Jelly-like stool (mixed with blood and mucous) or Mucoid stool (due to necrosis of the bowel)
• Screaming and drawing legs up to abdomen (highly painful) but they will have periods of calm in between episodes
• Sausage like mass in right upper quadrant
• Distended abdomen

Management
- Barium Enema (used to diagnose and treat) - Pressure from this can help telescoping of bowel to return to normal position.
- IV fluids
- NG decompression

• If enema does not work then surgery is done