Babies and Intestinal Malrotation

If you are like most kids, you probably don’t think about your intestines very much!  But they are a very important part of your body: it is your intestines that absorb the nutrients from the food that you eat — and if something goes wrong with them, it can interfere with the way you eat and also pass stool (go to the bathroom).

Let’s talk about this fairly common problem with the intestines, a problem called intestinal malrotation.

What is Intestinal Malrotation?

Intestinal malrotation is a condition which occurs during pregnancy, when the baby’s intestines don’t get into a normal position as they develop. As a result, they don’t attach themselves in the right place. This is a fairly common condition, and happens in 1 out of every 200-500 births.

Curiously enough, this condition was first described as far back as 1900. It was in 1936 that Dr. Willis Ladd wrote a classic article on how to treat this problem:  the so-called “Ladd’s procedure” is still in use to treat intestinal malrotation today!

What Causes Intestinal Malrotation?

Intestinal malrotation occurs before the baby is ever born, but often the exact cause for why this happens is unknown.  However, often, this can happen in babies who have other problems at birth as well, such as other digestive defects, heart defects or problems with their liver or spleen. It can also be caused by hernias, the growth of scar tissue after an operation or inflammatory bowel disease.

Who is at Risk for Intestinal Malrotation?

While any baby can develop intestinal malrotation, some babies are at higher risk:

• Boys are twice as likely as girls to have this problem.
• 40% of babies are diagnosed within the first week of life, 75% in the first year.
• Other birth defects, such as the ones missed above.

What are the Signs and Symptoms of Intestinal Malrotation?

There are some definite signs and symptoms which can go along with this condition. These can include:

• Pulling up legs and crying every 20-30 minutes due to the recurrent spasms
• Diarrhea or constipation
• Vomiting and inability to hold down solid food
• Failure to thrive (this means that the baby is not growing and gaining weight the way it should)
• Stomach pain and swelling
• Irritability
• Lack of energy
• Fever
• Increased heart rate and breathing

What Complications can Come from Intestinal Malrotation?

Unfortunately, there are many complications that can come from this condition. These can include:

• Babies going into shock can suffer from low blood pressure, decreased urine output and poor circulation
• Malnutrition, if the problem is not treated; this is because the baby’s intestines cannot absorb the nutrients the body needs to develop in the right way
• Continuing bowel problems if the first operation causes adhesions

How Does the Doctor Know if a Baby Has this Condition?

There are several techniques a doctor can use in order to diagnose intestinal malrotation, including:

• Signs and symptoms
• Imaging techniques like an ultrasound or CT scan or an X-ray with the use of contrast dye or barium.

How is Intestinal Malrotation Treated?

To treat intestinal malrotation, doctors will take a naso-gastric tube and remove food or air from the baby’s stomach and intestines to relieve pressure and pain.  They will also put the baby on IV fluids to prevent dehydration and to be able to give them antibiotics.

Doctors will also have to do surgery and use the Ladd procedure to straighten and re-attach the bowels. They also will remove the appendix.

Sometimes the surgeon will even have to take part of the bowel and make an opening for it in the stomach called a stoma. In order to let the colon rest, the child will have to pass stools (poop) through this stoma and into a small bag that it attached to the stomach (called a colostomy bag).  This may sound pretty gross, but the good news is that usually this is just temporary. After the bowel has rested, another surgery will be needed to reattach the intestines so that the child can good to the bathroom normally again.

However, with treatment, this condition can be corrected and children with this problem can go on to lead happy, healthy and normal lives.

Intestinal malrotation does sound pretty scary — and it is considered to be a serious condition. However, with surgery, intestinal malrotation can be corrected with little lasting damage, especially if it is treated early.