Children with symptoms caused by malrotation need surgery to move their intestines. If they have volvulus, they need surgery right away. Volvulus is a life-threatening emergency. If they do not have volvulus, they may not need surgery right away. But surgery is important to clear any blockage and to reduce the chance for volvulus.
Even if your child has had no symptoms of malrotation, talk with a surgeon about whether your child should have surgery to correct it. Nearly all children need surgery to prevent serious problems later. A surgeon can explain the risks and benefits and help you decide what’s best for your child.
Malrotation Treatment Options
Surgery to move the intestines
Before surgery, your child will need a nasogastric (NG) tube, which goes through their nose to their stomach, to empty their stomach.
They will also need IV (intravenous) fluids to prevent dehydration, to give them nutrients and to give them antibiotics to prevent infection. This will be part of your child’s care before, during and after surgery.
At the time of surgery, we give your child medicine to make them sleep without pain (general anesthesia).
The surgeon makes a small cut (incision) above the belly button and brings the intestines out through this opening. The surgeon untwists the intestines and cuts the Ladd’s bands (bands of tissue that attach the first part of small intestine to the first part of the large intestine).
During the surgery, the surgeon checks the health of the intestines. The surgeon looks for a pink color in the tissue, which shows that blood flow is good. If the tissue looks healthy, the surgeon folds the small intestine into the right side of the belly (abdomen) and the large intestine (colon) into the left side of the belly. The intestines are placed so they are not likely to twist in the future.
The new placement of the intestines is not the same as the normal placement. This means your child’s appendix (a small organ attached to the colon) is not in the usual place. If your child ever got appendicitis, it might be hard to diagnose. So your surgeon takes out your child’s appendix during the surgery for malrotation. (The appendix has no clear function, and people live normally without it.) Then the incision is closed.
If it’s not clear that the intestine has good blood flow, your child may need another surgery within 24 to 48 hours to recheck the intestine. If a segment of intestine does not look healthy, the surgeon may remove that segment.
Surgery to remove a segment
Part of the intestine may be damaged or the tissue may die if it isn’t getting good blood flow. If a segment of your child’s intestine is damaged, the surgeon will remove that segment. The goal is to keep as much healthy intestine as possible.
Surgeons cut on each side of the damaged segment and take it out. If the rest of the intestine looks healthy, they sew the two ends of the intestine together (primary anastomosis, pronounced an-as-toe-MOE-sis). If it does not look healthy, they may make an ostomy (pronounced OST-uh-mee). They make two small openings (stoma) in your child’s belly. Each open end of the intestine is then sewn to one of the openings. One of these lets waste come out of the body into a plastic pouch attached on the outside. The other opening is used to clean the lower intestines. If your child needs this procedure, you will get instructions about how to care for the stoma.
In most cases, an ostomy is temporary. Later, when the intestine is healthier, the surgeon does another surgery to attach the two ends of the intestine and close the stoma. Usually this is about eight weeks later. If a child had to have a large segment of intestine removed, the ostomy might be permanent. This is not common. If your child needs a large segment of intestine removed, they may be at risk for short bowel syndrome. The surgeon will keep as much intestine as possible to try to prevent this.
After surgery, your child will be in the recovery room for about an hour and then go to a room in the hospital. Some children who are quite ill stay in our intensive care unit (ICU) or neonatal ICU (NICU), where they get the high level of care they need. When they’re ready, they move to a regular hospital room and eventually to home.
The length of hospital stay for children with malrotation is usually about a week. This depends on factors like how quickly the intestine recovers from surgery and how soon the child can start eating again.
Right after surgery, your child will get all their nutrition through an IV (intravenous) line. They need this because their intestine goes to sleep, in a sense, after surgery. It takes a few days for the intestine to work again. After the child starts passing gas, the doctors will know the intestine is working again and feedings may be started. Some babies may have to get feedings through a tube that goes through the nose or mouth into the stomach (nasogastric tube, NG tube; or orogastric tube, OG tube).
We will give your child pain medicine to make them comfortable.
The surgeon will stay closely involved in your child’s care while they are in the hospital. When your child goes home, the surgeon will schedule a follow-up visit two to three weeks after the surgery to make sure the incision is healing.