Malrotation, or volvulus, which occurs during childhood, is a twisting off of the bowel with blockage so that stool cannot pass, and blood and oxygen cannot get to the tissues that are twisted off. This can result in death of some or all of the intestines.
While the baby is still in the womb, the intestines can become twisted or malrotated. This also can happen within the first year of life. The condition usually is noticed by parents when the baby suddenly becomes constipated with nausea and vomiting, bloody stools, abdominal pain and shock. The baby’s abdomen may stick out or be distended.
When the baby is taken to the emergency room, a test of the stool may be done to determine whether the stool has blood in it. The doctor may then order what’s called an upper GI. This means that the baby will be given fluid to drink followed by X-rays, which show if the fluid is going through or not. A CT scan, blood tests and other X-rays also may be ordered. Other than the blood tests, none of these is painful. The blood test involves your baby being stuck with a needle.
Once the diagnosis is made, emergency surgery is necessary. With the baby under general anesthesia, the surgeon makes an incision in the abdomen. The bowels are inspected for damage, and dead or damaged portions are removed and the healthy portions are sewn together. The bowels are untwisted and their blood supply becomes normal again. If a small section of bowel is dead or damaged, a colostomy or ileostomy may be inserted either temporarily or permanently, depending upon how much “good” bowel is left. This ostomy drains stool from the intestines.
The child will have a tube inserted through his or her nose down to the stomach to rest the stomach. As soon as the bowels are awake, the nurses begin slow feedings. The baby will be in the ICU for a day or so after surgery to be monitored and kept warm.
Before you go home with your child, an ostomy nurse will help you understand how to take care of the colostomy or ileostomy. The nurses also will tell you how to take care of any bandages.
Early recognition and treatment are very important because this is an emergency condition.
For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.