Visit our foundation to give a gift.
View Locations Near Me
Main Campus – Hartford
Connecticut Children’s – Waterbury
Urgent Care – Farmington
Specialty Care Center – Danbury
Connecticut Children’s Surgery Center at Farmington
Specialty Care Center – Fairfield
Search All Locations
Find a doctor
Find A Doctor
Request an Appointment
Amenities and Services
Who’s Who on Care Team
Getting Ready for Surgery
What to Expect—Picture Stories
Pay a Bill
Understanding the Different Fees
Pricing Transparency and Estimates
Raytheon Technologies Family Resource Center
Family Advisory Council
Legal Advocacy: Benefits, Education, Housing
Electronic Health Records
Share Your Story
Pay a Bill
Login to MyChart
Clinical Support Services Referrals
About the Network
Join the Network
Graduate Medical Education
Continuing Medical Education
MOC/Practice Quality Improvement
Educating Practices in the Community (EPIC)
Learning & Performance
Meet our Physician Relations Team
Request Medical Records
Join our Referring Provider Advisory Board
View our Physician Callback Standards
Read & Subscribe to Medical News
Register for Email Updates
Update Your Practice Information
Refer a Patient
Find and Print Health Info
Health Information For Parents
An intestinal malrotation is an abnormality that can happen early in pregnancy when a baby’s intestines don’t form into a coil in the abdomen. Malrotation means that the intestines (or bowel) are twisting, which can cause obstruction (blockage).
Some kids with malrotation never have problems and the condition isn’t diagnosed. But most develop symptoms and are diagnosed by 1 year of age. Although surgery is needed to repair malrotation, most kids will go on to grow and develop normally after treatment.
The 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’re folded up, they fit into the relatively small space inside the abdomen.
When a fetus develops in the womb, the intestines start out as a small, straight tube between the stomach and the rectum. As this tube develops into separate organs, the intestines move into the umbilical cord, which supplies nutrients to the developing embryo.
Near the end of the first trimester of pregnancy, the intestines move from the umbilical cord into the abdomen. If they don’t properly turn after moving into the abdomen, malrotation occurs. It happens in 1 out of every 500 births in the United States and the exact cause is unknown.
Some children with intestinal malrotation are born with other associated conditions, including:
Malrotation can lead to these complications:
An intestinal blockage can prevent the proper passage of food. So one of the earliest signs of malrotation and volvulus is abdominal pain and cramping, which happen when the bowel can’t push food past the blockage.
A baby with cramping might:
Infants also may be fussy, lethargic, or have trouble pooping.
Vomiting is another symptom of malrotation, and it can help the doctor determine where the obstruction is. Vomiting that happens soon after the baby starts to cry often means the blockage is in the small intestine; delayed vomiting usually means it’s in the large intestine. The vomit may contain bile (which is yellow or green) or may resemble feces.
Other symptoms of malrotation and volvulus can include:
If volvulus or another intestinal blockage is suspected, the doctor will examine your child and then may order X-rays, a computed tomography (CT) scan, or an abdominal ultrasound.
The doctor may use barium or another liquid contrast agent to see the X-ray or scan more clearly. The contrast can show if the bowel has a malformation and can usually find where the blockage is.
Adults and older kids usually drink barium in a liquid form. Infants may need to be given barium through a tube inserted from the nose into the stomach, or sometimes are given a barium enema, in which the liquid barium is inserted through the rectum.
Treating significant malrotation almost always requires surgery. The timing and urgency will depend on the child’s condition. If there is already a volvulus, surgery must be done right away to prevent damage to the bowel.
Any child with bowel obstruction will need to be hospitalized. A tube called a nasogastric (NG) tube is usually inserted through the nose and down into the stomach to remove the contents of the stomach and upper intestines. This keeps fluid and gas from building up in the abdomen. The child may also be given intravenous (IV) fluids to help prevent dehydration and antibiotics to prevent infection.
During the surgery, which is called a Ladd procedure, the intestine is straightened out, the Ladd’s bands are divided, the small intestine is folded into the right side of the abdomen, and the colon is placed on the left side.
Because the appendix is usually found on the left side of the abdomen when there is malrotation (normally, the appendix is found on the right), it is removed. Otherwise, should the child ever develop appendicitis, it could complicate diagnosis and treatment.
If it appears that blood may still not be flowing properly to the intestines, the doctor may do a second surgery within 48 hours of the first. If the bowel still looks unhealthy at this time, the damaged portion might be removed.
If the child is seriously ill at the time of surgery, an ileostomy or colostomy usually will be done. In this procedure, the diseased bowel is completely removed, and the end of the normal, healthy intestine is brought out through an opening on the skin of the abdomen (called a stoma). Fecal matter (poop) passes through this opening and into a bag that is taped or attached with adhesive to the child’s belly.
In young children, depending on how much bowel was removed, the ileostomy or colostomy is often a temporary condition that can later be reversed with another operation.
Most of these surgeries are successful, although some kids have recurring problems after surgery. Recurrent volvulus is rare, but a second bowel obstruction due to adhesions (scar tissue build-up after any type of abdominal surgery) could happen later.
Children who had a large portion of the small intestine removed can have too little bowel to maintain adequate nutrition (a condition known as short bowel syndrome). They might need intravenous (IV) nutrition for a time after surgery (or even permanently if too little intestine remains) and may require a special diet afterward.
Most kids in whom the volvulus and malrotation are found and treated early, before permanent injury to the bowel happens, do well and develop normally.
If you suspect any kind of intestinal obstruction because your child has bilious (yellow or green) vomiting, a swollen abdomen, or bloody stools, call your doctor immediately, and take your child to the emergency room right away.
Hernias are fairly common in kids, and hernia repair is one of the most common pediatric surgeries.
Your child’s doctor may order a stool collection test to check for blood, bacteria, ova, or parasites. Find out how this test is performed and when you can expect the results.
Intussusception is the most common cause of bowel blockages in very young children. Quick treatment can help them recover without lasting problems.
The digestive process starts even before the first bite of food. Find out more about the digestive system and how our bodies break down and absorb the food we eat.
The lymphatic system is an extensive drainage network that helps keep bodily fluid levels in balance and defends the body against infections.
Most vomiting is caused by gastroenteritis, and usually isn’t serious. These home-care tips can help prevent dehydration.
Inflammatory bowel disease (IBD) refers to two chronic diseases that cause intestinal inflammation: ulcerative colitis and Crohn’s disease. Although they have features in common, there are some important differences.
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
© 1995-2020 KidsHealth®. All rights reserved.
Images provided by The Nemours Foundation, iStock, Getty Images, Veer, Shutterstock, and Clipart.com.