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Common symptoms of malrotation in babies under 1 year of age include abdominal pain and cramping, nausea, vomiting, bloating, bloody stools, and more

Malrotation occurs when an infant’s intestinal tract has not developed properly in the abdomen. Common symptoms of malrotation in babies under 1 year of age include: 

• Abdominal pain and camping
• Nausea
• Vomiting fluid that may be green in color due to the presence of bile
• Bloating
• Constipation
• Diarrhea
• Infrequent bowel movements
• Bloody stools
• Little or no urine
• Lethargy
• Fever

If malrotation and its complications obstruct blood flow to the intestines and lead to shock, symptoms may include:

• Confusion or unconsciousness
• Fast heart rate
• Pale skin
• Sweating

What is malrotation?

Malrotation is a congenital condition in which a baby’s intestine does not form and rotate correctly in the abdomen. It occurs during early pregnancy at about 10 weeks.

Some babies with malrotation may experience symptoms and complications after a few months, whereas others babies may remain asymptomatic or not face any complications throughout their life. 

Symptoms start to become evident when the intestine twists abnormally in a condition known as volvulus. Volvulus can lead to obstruction or blockage in the intestine, preventing normal digestion. At times, the blood supply to this area may be obstructed, leading to necrosis or death of that part of the intestine, which is a medical emergency. Surgery can successfully treat volvulus, and the baby can grow and develop normally.

How common is malrotation?

In the United States, 1 in every 500 babies suffers from malrotation. Only 1 in 6,000 babies may show symptoms associated with malrotation, with 60% of cases diagnosed in the first week of life.

The exact cause of malrotation is unknown and can occur equally in boys and girls. However, symptoms are more commonly seen in boys than in girls and typically occur within the first month of life.

What are complications of malrotation?

Potential complications of malrotation may include:

• Obstructed blood flow to the twisted part of the intestine and death of that segment 
• Perforation (hole) in the intestinal wall
• Peritonitis (an infection of the lining of the abdominal cavity)
• Sepsis (a serious illness that occurs when the body has an overwhelming immune system response to an infection)
• Shock

Pancreatitis is inflammation of an organ in the abdomen called the pancreas.
See Answer

How is malrotation treated?

Malrotation is a medical emergency, and volvulus is a life-threatening condition that requires surgery. The following guidelines may be used to treat malrotation:

• Intravenous fluids may be administered to prevent dehydration. Antibiotics may be given to prevent infection and the baby may be sedated.
• The baby’s intestine is unwound and checked for damage. If the intestine is free of damage, it’s then repositioned in the abdomen.
• If there is an obstruction of blood flow to the intestine, it can be untwisted and placed into the abdomen.
• To check the status of the intestine, the surgeon may perform another operation within 24-48 hours. If the intestine appears to have damage, it may be removed.

If a large section of the intestine appears to be damaged, a significant amount of the intestine may be excised. In this case, the remaining portion of the intestine may not be attached correctly. 

To correct this issue, a colostomy may be performed in order to keep the digestive system functioning. The colostomy brings the ends through the openings in the abdomen. Stool will pass through the opening (stoma) and finally into the collection bag. This procedure can be permanent or temporary depending on the amount of intestine that is removed.