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Malrotation, Emergency Medicine

Moon O. Lee Reviewed 06/2017
 


Basics

Description

  • Incomplete rotation and fixation of intestine during embryogenesis during transition from extracolonic position during week 10 of gestation

  • Risk factor:

    • Heterotaxia syndromes

  • Associated...

Diagnosis

Signs and Symptoms

  • Neonates:

    • Bilious emesis

    • Abdominal distention

    • Bloody stools

    • Constipation/obstipation

    • Difficulty feeding

    • Poor weight gain

  • >1 yr: Abdominal pain followed by bilious emesis

  • Older c...

Treatment

Midgut volvulus may result in need for rapid volume and electrolyte replacement/resuscitation to correct severe hypovolemia and metabolic acidosis. 

Pre-Hospital

Rapid transport to ED 

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • Acute abdomen

  • Surgical intervention

  • Significant dehydration

  • Acidosis

  • Sepsis

  • Shock

Discharge Criteria

Stable, asymptomatic, incidental finding without associated conditi...

Pearls and Pitfalls

  • Early recognition of child with acute abdomen

  • Prompt treatment of acidosis and shock

  • Prompt referral to appropriate facility

Additional Reading

  • Applegate  KE. Evidence-based diagnosis of malrotation and volvulus. Pediatr Radiol.  2009;39:S161–S163.

  • Fleisher  GR, Ludwig  S, eds. Textbook of Pediatric Emergency Medicine. ...

Codes

ICD9

751.4 Anomalies of intestinal fixation 

ICD10

Q43.3 Congenital malformations of intestinal fixation 

SNOMED

  • 29980002 Congenital malrotation of intestine (disorder)

  • 25617003 Congenital duodenal ob...

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