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PE1375 Intestinal Malrotation

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PE1375 Intestinal Malrotation Patient and Family Education Intestinal Malrotation What is intestinal malrotation? This flyer explains intestinal malrotation, Intestinal malrotation is when a baby’s intestines do not become fixed in the when surgery is belly (abdomen) correctly while they are in the womb. Before birth, the needed and how to intestines are supposed to grow and then stick in a certain position so they care for your child cannot twist around inside the belly. With malrotation, the intestines do not after surgery. stick in the right spot and can get twisted. What are the symptoms of malrotation? Some children with malrotation never have symptoms and are never diagnosed. But most develop symptoms during infancy, and almost all are diagnosed by 1 year of age. The most common sign of malrotation is vomiting. Belly pain may occur after a few hours when the twist has caused the blood supply to the intestine to be cut off. There may also be: • Fussiness or crying and nothing seems to help • Tiredness or no energy • Irregular bowel movements • A swollen belly that is painful when touched How is it diagnosed? If your child has symptoms the doctor will do a full exam. Your child will also have an X-ray test called an upper GI. Before the X-ray, your child will drink some X-ray contrast, or it will be put in the stomach with a nasogastric (NG) tube. This is a tube that goes through the nose and into the stomach. This liquid will show on the X-ray and show if the intestines are twisted. When is surgery needed? If your child has malrotation, your surgeon will speak to you about planning for surgery. Malrotation may not cause any problems right away but it can lead to other complications. Almost all children will need surgery. Most kids will go on to grow normally after surgery. Sometimes the surgery must be done as an emergency. Surgery is needed right away if: • Your child has a condition called volvulus. This is when the bowel twists on itself, cutting off the blood flow to the tissue and causing the tissue to die. • The blockage of the bowel caused by volvulus or Ladd’s bands (bands of tissue that can block the intestine) is life-threatening. The bowel can stop working and the intestinal tissue can die from lack of blood supply if the blockage isn’t treated. 1 of 3 Intestinal Malrotation What happens during surgery? At the time of surgery, we will give your child medicine (anesthesia) to make them sleep without pain. Your child’s surgeon will make a small cut just above the belly button and take out all the intestines to look at them and rearrange them. The surgeon will also remove the appendix, because after surgery it will not be in the normal spot. Instead of being in the lower right side, it will be in the upper left part of the belly. This could be confusing and make it hard to diagnose if your child gets appendicitis in the future. In some children the twist has caused part of the intestine to die. In those cases that part of the intestine has to be cut out and the remaining parts sewn together. There are also bands of tissue called Ladd’s bands and these can block the intestine. These will be cut to reduce the risk of future blockage. What happens after surgery? When your child wakes up after surgery they will have an NG tube. This is needed because the intestines take a few days to start working normally. The tube drains the stomach contents so your child doesn’t throw up. It will need to stay in place for about 3 to 5 days. When the doctor thinks your child’s intestines are working again, they will take the tube out. Your child will be able to slowly start eating and drinking again. Will my child be in pain? We partner with you and your child to prevent and relieve pain as completely as possible. You know your child best. We encourage you to take an active part in your child’s recovery by talking with your care team about options for your child. After a surgery your child is likely to have some pain and discomfort. In addition to medicine prescribed for pain, we will work with you to create a plan that encourages coping activities to treat pain and provide support. No matter the level of your child’s pain, we join you to assess and respond right away. Help your child get better faster with good pain management. When will my child be able to go home? Your child will be able to go home when they are eating and drinking normally for their age, and pain is under control. Most kids stay in the hospital for 5 to 7 days after surgery. How do I care for my child at home? Incision • If skin glue (dermabond) is used to cover the cut, it is okay to bathe and shower 2 days after surgery. • If Steri-Strips are used to cover the cut, then it is okay to shower 2 days after surgery but no tub bathing or swimming for a week after surgery. These will usually fall off or peel off in 10 to 14 days. 2 of 3 Intestinal Malrotation • To Learn More The cut will be closed with dissolvable stitches. You won’t see any stitches on the outside skin. • General Surgery • A little blood from the surgery is normal. 206-987-2794 Diet • Ask your child’s healthcare provider • When the NG tube is removed your child will be able to slowly start eating • seattlechildrens.org and drinking again. • Your child will start eating their regular diet before they leave the hospital. Activity • For older children, avoid rough play, contact sports, bicycle riding and Free Interpreter playground climbing equipment until your child’s surgeon says it’s OK. Services Follow-up visit • In the hospital, ask your child’s nurse. • You will return to clinic to see your child’s surgeon about 2 to 4 weeks after • From outside the your child’s surgery. hospital, call the toll-free Family When should I call the doctor? Interpreting Line Please call the doctor if your child has: 1-866-583-1527. Tell • Fever of 101.5° F or higher for more than 24 hours the interpreter the name or extension you • Vomiting need. • No passing of gas or stool • Redness that spreads from the incision site • New bleeding or drainage from the incision site • Severe, constant pain at the surgery site that does not improve with prescribed pain medicine If you have questions or concerns, please call the nurse in the General Surgery Clinic at 206-987-2794. After hours or on weekends call 206-987-2000 and ask to page the on-call General Surgeon. Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the Family Resource Center at 206-987-2201. 12/18 This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s needs are unique. Before you act PE1375 or rely upon this information, please talk with your child’s healthcare provider. © 2018 Seattle Children’s, Seattle, Washington. All rights reserved. General Surgery 3 of 3 .
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