Aug 28, 2006


What is Malrotation? Malrotation is a type of mechanical obstruction caused by abnormal development of the intestines while a fetus is in the mother's womb. The small and large intestines are the longest part of the digestive system.If stretched out to their full length, they would measure more than 20 feet long by adulthood,but because they are coiled up, they fit into the relatively small space of abdominal cavity. Malrotaion occurs when the intestines don't "coil" properly during fetal development.Malrotation in itself may not cause any problems. However it may be accompanied by additional complications:

1] Bands of tissue called Ladd bands may form, obstructing the first part of the small intestine (the duodenum). 2] After birth, volvulus may occur. This is when the intestine twists on itself, causing a lack of blood flow to the tissue and leading to tissue death. Malrotation is often diagnosed when volvulus occurs, frequently during the first weeks of life.
Obstruction caused by volvulus or Ladd bands are both life-threatening problems. The intestines can stop functioning and intestinal tissue can die from lack of blood supply if an obstruction isn't recognized and treated. Surgery to correct bowel obstruction from malrotation is always necessary and is often performed as an emergency procedure to prevent irreversible, life-threatening injury to the bowel. During surgery, which is called a Ladd procedure, the intestine is straightened out, the Ladd bands are divided, the small intestine is coiled on the right side of the abdomen, and the colon is placed on the left side.


mommynik said...

Hi, I'm curious as to why you described malrotation when you did - did you have a patient who experienced/presented this defect?
My son was diagnosed via UGI on April 23 & had Ladds Procedure on April 24. He had not experienced volvulus, but rather, we were following up on my belief that he might have reflux.
My frustration is the reactive nature of diagnosis. The surgeon herself said that if I had come in, complaining of the symptoms I had detected in my son, she would not have even ordered a UGI. I saw that he had reduced BM's to every 2-4 days at around 3 months. Those BM's were very red/green and seemed super stinky, as well as stinky gas a lot of the time. He seemed to twist and contort his body while nursing, after nursing and even when waking (early) from naps. He seemed always fussy (with some bright spots of course) and his reflux seemed to be getting worse (he hadn't seemed to have it early on, but after about 3.5 months it seemed more likely that he had it, which seemed odd to me, and the reason I went to a Pediatric Gastroenterologist).
Have you seen similar "symptoms" in your patients? Am I just a very observant person or overly neurotic? I feel that if I hadn't pushed, we would have had to wait until he had volvulus and then possibly death of the bowel/tissue.
How late that would have been!
(btw he had surgery at 6 months)