[25] Malrotation and Volvulus Flashcards

1
Q

What is malrotation?

A

An abnormality of the bowel that occurs during development where the bowel does not sit properly in the abdomen

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2
Q

When does malrotation most commonly become evident?

A

When midgut volvulus occurs

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3
Q

What is a volvulus?

A

A complication of malrotation where the bowel twists on itself, cutting off its own blood supply

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4
Q

When does malrotation occur?

A

Due to improper development beginning at around the 10th week

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5
Q

How is the bowel supposed to develop at around 10 weeks?

A

The bowel temporarily moves into the umbilical cord to develop and is supposed to move back into the abdomen at 10 weeks

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6
Q

What goes wrong during development to cause malrotation?

A

Inappropriate coiling as the bowel moves back into the abdomen

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7
Q

What type of volvulus typically occurs as a result of malrotation?

A

Midgut (small intestine) volvulus

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8
Q

Who do small gut volvuluses most commonly occur in?

A

Children

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9
Q

What type of volvulus is more common in adults?

A

Sigmoid volvulus

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10
Q

What is the radiological sign for a sigmoid volvulus?

A

Coffee bean sign

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11
Q

How may malrotation present?

A
  • Acute process

- Chornic process

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12
Q

What is the acute process seen in malrotation?

A

Acute midgut volvulus

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13
Q

When does an acute midgut volvulus usually present?

A

In the first year of life

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14
Q

How does an acute midgut volvulus usually present?

A
  • Sudden onset bilious emesis
  • Diffuse abdominal pain
  • Abdominal distension
  • Melena/haematemesis
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15
Q

What causes melena/haematemesis to occur?

A

Intraluminal bleeding due to vascular compromise

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16
Q

What can worsening ischaemia lead to?

A

Signs of shock

17
Q

What are the signs of shock?

A
  • Poor perfusion
  • Decreased urine output
  • Hypotension
  • Raised lactate
  • Base deficit
18
Q

What is the chronic process seen in malrotation?

A

Chronic midgut volvulus

19
Q

How may chronic midgut volvulus present?

A
  • Recurrent abdominal pain
  • Malabsorption syndrome
  • Recurrent diarrhoea +/- constipation
  • Intolerance of solids
  • Obstructive jaundice
  • Gastro-oesophageal reflux
20
Q

What are the blood tests for volvulus and malrotation?

A
  • FBC
  • ABG/VBG
  • Lactate
  • G&S
21
Q

What imaging investigations are useful in a suspected volvulus?

A
  • Ultrasound
  • Upper GI series
  • Lower GI series
22
Q

What will an ultrasound show?

A

Can diagnose malrotation with/without volvulus

23
Q

Why is an upper GI series useful?

A

It is the standard diagnostic test for intestinal malrotation

24
Q

What is required in a lower GI series?

A

Contrast enema

25
Q

When is a lower GI series used?

A

When an upper GI series cannot define the location of the duodenal-jejunal junction

26
Q

What are the differentials for malrotation and volvulus?

A
  • Bowel obstruction in the newborn
  • Necrotising enterocolitis
  • Neonatal sepsis
  • Duodenal atresia
  • Gastro-oesophageal reflux
27
Q

How should a volvulus be managed initially?

A

Medical stabilisation

28
Q

How may a patient with a volvulus be medically stabilised?

A
  • NG tube
  • Correction of fluid and electrolyte losses
  • Correction of shock if present
29
Q

What is the definitive surgical treatment of a volvulus?

A

Ladd procedure

30
Q

What does the Ladd procedure involve?

A

Reduction of the volvulus, division of the mesenteric bands, placing the small bowel on the right, large bowel on the left and an appendectomy

31
Q

What must be decided after reduction of the volvulus?

A

Whether parts of the bowel are non-viable

32
Q

What should happen to grossly necrotic bowel?

A

Resection

33
Q

What are the potential complications of a volvulus?

A
  • Short bowel syndrome
  • Infection, including wound infections and sepsis
  • Persistent GI symptoms