Malrotation

Question 1

What is malrotation?

Answer 1

Abnormal development of the midgut during embryogenesis

Making the bowel more susceptible to volvulus

Question 2

When should the midgut roate?

Answer 2

Rotations and fixation should take place between 4th and 12th weeks of gestation

Question 3

What is volvulus and how does this link to malrotation?

Answer 3

Bowel twisting

Duodenal compression by peritoneal bands = ladd bands

Question 4

Clinical features of malrotation?

Answer 4

Bilious vomiting within the first day of life

This is due to obstruction being below the ampulla of vater

Distended abdomen

Question 5

What is the ampulla of vater?

Answer 5

(where the hepatopancreatic duct joins the duodenum).

If obstruction is below here = bilious vomiting e.g. malrotation

Question 6

How to investigate for malrotation?

Answer 6

Upper GI contrast study is gold standard

Proximal bowel may demonstrate corkscrew apperance

Question 7

How to manage malrotation?

Answer 7

Vascular compromise = emergency laparotomy

Ladd procedure: surgically dividing the ladd band

Give Cefazolin ABX