GASTROINTESTINAL SYSTEM BLOCK

CASE 4B

Ronald Chrisbianto Gani 405090223 Faculty of Medicine 2009 Tarumanagara University

MALROTATION

MALROTATION
Malrotation : Incomplete rotation of the intestine during fetal development Nonrotation : the bowel fails to rotate after it returns to the abdominal cavity Most common type of malformation involves failure of the cecum to move into the right lower quadrant, and the cecum is located in the subhepatic
Nelson Textbook of Pediatrics 18th ed

MALROTATION

Nelson Textbook of Pediatrics 18th ed

CLINICAL MANIFESTATION
1st week of life : bulious emesis and acute bowel obstruction Older infant : reccurent abdominal pain can mimic colic Older children : reccurent vomiting and abdominal pain. 25-50% adolescents patient with malrotation are asymptomatic Symptomatic adolescents : acute intestinal obstruction, reccurent episodes of abdominal pain with less vomiting or diarrhea Patient at any age may develop acute bowel threatening volvulus Acute presentation of small bowel obstruction because of volvulus is a life threatening complication of malrotation

Nelson Textbook of Pediatrics 18th ed

DIAGNOSIS
Ultrasound Contrast radiographic studies Abdominal plain film : double-bubble sign duodenal obstruction Barium enema : malposition of cecum (normal in 10% cases) USG : inversion of the superior mesentric artery and vein
Nelson Textbook of Pediatrics 18th ed

TREATMENT
Surgical intervention is reccomended If a volvulus is present, the surgery is done immediately to freed any bands Persistent symptoms after repair of malrotation should suggest a pseudoobstruction-like motility disorder

Nelson Textbook of Pediatrics 18th ed

REFERENCES
Nelson Textbook of Pediatrics 18th ed