Volvulus (Malrotation of the Gut)

A malrotation of the gut occurs when something goes wrong during development the small intestine (gut or small bowel). When this occurs, the small intestine is not fixed in the abdomen (belly). The intestines are held by just their blood supply. When the intestines become twisted, because they are not fastened down, it cuts off their blood supply. It is much like a hose getting kinked. This loss of blood supply leads to damage to the gut. This condition is also called volvulus.

SYMPTOMS

Most often this abnormality shows up during the first month of life. Sometimes it may not produce symptoms until adulthood. Usually the abdomen becomes distended and there is vomiting of bilious material. This is greenish or bile stained vomitus. There is usually cramping and intermittent abdominal pain.

DIAGNOSIS

The diagnosis can be made with an upper GI (gastrointestinal) X-ray. This is an X-ray study using contrast material. Contrast material is something given to the baby by mouth that shows the inside of the stomach and small bowel better. This X-ray shows an abnormal position of the first part of the small bowel located where the small bowel first leaves the stomach.

TREATMENT

A volvulus is a surgical emergency. This must be corrected immediately to preserve life.

  • The surgeon will untwist the intestine if necessary.

  • The surgeon will cut through the abnormal bands holding the organs in the wrong places.

  • The appendix will be removed. If the child were to have an appendicitis the diagnosis would be dangerously delayed because of the abnormal position.

  • After the operation, it is extremely unlikely the bowel will rotate again. The body has internal scarring called adhesions that hold things in place.