Malrotation in a child Flashcards
What is the definition of malrotation?
When the midgut doesn’t rotate fully around the superior mesenteric artery and the caecum ends up in the RUQ (instead of the RLQ)
What is the definition of volvulus?
A complication of malrotation
Complete twisting of an intestinal loop around the mesentery
What 2 broad things can happen in malrotation?
Small mesenteric base around which the bowel can rotate –> volvulus
Formation of Ladd bands from the peritoneum anterior to duodenum –> duodenal obstruction
What are the presenting features of malrotation?
Intermittent symptoms of obstruction Bilious vomiting for the 1st few days of life Non-bilious vomiting >2 months Failure to thrive Anorexia Constipation Recurrent abdo pain
In which patients is recurrent abdo pain more common in malrotation?
In older children
What are the presenting features of volvulus?
Rapid onset bilious vomiting --> Metabolic acidosis Lactic acidosis Oliguria Hypotension Shock Palpable abdo mass Acute abdomen = distension and signs of peritonitis Gangrene
What are the signs of gangrene in volvulus?
Tachycardia
Hypovolaemia
Septic shock
How is a diagnosis of malrotation or volvulus made?
Clinically
What is the role of investigations in malrotation?
Used for monitoring the severity of the disease
What lab investigations could be done in malrotation?
FBC - +WCC, +CRP
U+Es to detect dehydration, sepsis, and acidosis
What results from U+Es would suggest dehydration, sepsis, or acidosis in malrotation?
-Na+, +K+, met. acidosis, +urea, +creatinine, lactic acidosis
What signs of malrotation are seen on X-Ray?
Dilated small loops
Air-fluid levels
But may be normal
What signs of partial obstruction are seen on X-Ray?
Stomach and proximal duodenal dilation, distal bowel gas
What signs of complete duodenal obstruction are seen on X-Ray?
Gasless abdomen
Multiple dilated loops
What would contrast studies show in malrotation?
Misplaced duodenojejunal junction (at or to R of midline)
