How is intestinal malrotation treated?

Updated: Dec 19, 2018
  • Author: Denis D Bensard, MD, FACS, FAAP; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Medical care of intestinal malrotation is directed toward stabilizing the patient.

Where malrotation with volvulus or obstruction is suspected, seek immediate pediatric surgical consultation. Maintain patients on nothing by mouth (NPO) and adjust NG or orogastric tube to low intermittent suction. Correct fluid and electrolyte deficits. All patients require intravenous resuscitation with physiologic salt solution. Administer broad-spectrum antibiotics prior to surgery, if possible.

If a patient has signs of shock, administer appropriate fluids, blood products, and vasopressor medications to improve hypotension. Dopamine is often used as first-line therapy because of its possible effects to increase splanchnic blood flow. Dopamine can be started at an infusion rate of 3 mcg/kg/min intravenously (IV) and continued postoperatively even if the patient is not hypotensive.

Most patients require long-term intravenous access after surgery, particularly if midgut volvulus is present. Additionally, intravenous nutrition is likely to be necessary. For this reason, central venous catheters should be placed in most patients.

If the patient is unstable, do not delay surgical intervention for upper GI and laboratory studies. Quick surgical intervention, not prolonged medical management, is associated with the best results if midgut volvulus is suspected.


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