Intestinal malrotation in children
- Mary L Brandt, MD
Mary L Brandt, MD
- Professor of Surgery, Division of Pediatric Surgery
- Baylor College of Medicine
- Section Editors
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
An overview of the presentation, diagnosis, and treatment of intestinal malrotation in children will be presented here.
Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut. Because rotational anomalies may remain asymptomatic throughout a person’s life span, the true incidence is not known. Nonrotation, a type of malrotation is an incidental finding on approximately 2 out of 1000 upper gastrointestinal contrast studies . Symptomatic malrotation in neonates occurs with a frequency of about 1 in 6000 live births.
Traditionally, intestinal malrotation has been considered primarily a disease of infancy with infrequent occurrence beyond the first year of life [2,3]. However, analysis of 2744 cases of intestinal rotation in children up to 17 years of age obtained from a national hospital discharge database found the following :
●Presentation by one month of age: 30 percent
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- Associated congenital defects
- EMBRYOLOGY AND PATHOGENESIS
- CLINICAL PRESENTATION
- Clinical suspicion
- Diagnostic approach
- - Intestinal perforation with peritonitis
- - Imaging in stable patients
- Patients with equivocal findings on imaging
- DIFFERENTIAL DIAGNOSIS
- Symptomatic malrotation
- - Laparoscopy
- Asymptomatic malrotation
- - Short gut syndrome
- - Small bowel obstruction
- Resolution of symptoms
- Recurrent volvulus
- SUMMARY AND RECOMMENDATIONS