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Management of Malrotation

  • Sophia Abdulhai
  • Abdulraouf Y. Lamoshi
  • Todd A. Ponsky
Chapter

Abstract

Malrotation classically presents as a full-term infant with bilious emesis. Any patient who presents with bilious emesis should be assumed to have malrotation with a midgut volvulus until proven otherwise. Initial workup should include a physical examination to rule out peritonitis or hemodynamic instability, followed by an abdominal X-ray to evaluate for proximal or distal bowel obstruction or a surgical emergency, such as pneumatosis or free air. Any patient with a worrisome physical exam or abdominal X-ray findings should be taken to the operating room (OR) emergently to rule out malrotation with midgut volvulus. The current gold standard in diagnosing malrotation is an upper gastrointestinal contrast study, and the key feature to look for is the location of the duodenal-jejunal junction (DJJ). In patients with an abnormal DJJ position, the treatment is a Ladd’s procedure. This chapter presents an algorithm that discusses the work-up and management of a patient with malrotation.

Keywords

Malrotation Bilious emesis Midgut volvulus Upper gastrointestinal contrast study Contrast enema Ladd’s procedure Duodenal-jejunal junction 

References

  1. 1.
    El-Gohary Y, Alagtal M, Gillick J. Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int. 2010;26(2):203–6.  https://doi.org/10.1007/s00383-009-2483-y.CrossRefPubMedGoogle Scholar
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    Ford EG, Senac MO, Srikanth MS, Weitzman JJ. Malrotation of the intestine in children. Ann Surg. 1992;215(2):172–8.CrossRefGoogle Scholar
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    Langer JC. Intestinal rotation abnormalities and midgut volvulus. Surg Clin North Am. 2017;97(1):147–59.  https://doi.org/10.1016/j.suc.2016.08.011.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sophia Abdulhai
    • 1
  • Abdulraouf Y. Lamoshi
    • 1
  • Todd A. Ponsky
    • 1
  1. 1.Division of Pediatric SurgeryAkron Children’s HospitalAkronUSA

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