How Are Intestinal Malrotation and Volvulus Treated?
Malrotation of the intestine is usually not evident until the intestine becomes twisted or obstructed by Ladd's bands, resulting in symptoms. Since a significant portion of the functional intestine can die with a volvulus, this is considered life-threatening.
Children are started on intravenous (IV) fluids to prevent dehydration, and antibiotics are administered to prevent infection. A nasogastric (NG) tube is placed from the nose into the stomach to prevent gas buildup in the stomach.
Surgical repair is performed as soon as possible. The bowel is untwisted and checked carefully for damage. Ideally, circulation to the intestine is restored after it is untwisted, allowing it to regain its pink coloration. If the intestine is healthy, an operation called the Ladd's procedure is performed to repair the malrotation. Since the appendix is not in the correct location, and it would be difficult to diagnose a future appendicitis, it is usually removed at this time.
If the blood supply to the intestine remains in question after untwisting, another operation is usually performed within 24 to 48 hours to re-evaluate it and determine the extent of bowel necrosis (death). If it appears that a section of intestine is severely damaged beyond recovery, this damaged portion is removed. This sometimes necessitates surgically creating a small bowel stoma (opening) through the abdominal wall to the skin. This diverts body waste into a collection bag, allowing the small bowel to heal. After several weeks, an operation may be performed to reconnect the bowel to the large intestine.
Long-Term Outlook
When surgical repair is performed before intestinal damage occurs, there are generally no long-term problems. However, removal of a large portion of intestine due to intestinal injury can severely affect the digestive process. With this operation, the normal intestinal process of absorbing nutrients and fluids cannot occur. Nutrition may need to be supplemented with long-term intravenous high-calorie solutions. This type of supplemental feeding is referred to as total parenteral nutrition (TPN). If the bowel does not recover its function and long-term TPN is necessary, children are at risk for developing chronic liver disease.
Mortality rates substantially increase with the presence of necrotic (dead) bowel at surgery and the presence of other co-existing abnormalities.