Malrotation/Volvulus


Malrotation usually presents in the first month of life with sudden onset of bilious vomiting.
Bilious vomiting should always be considered a surgical emergency
, and the neonate or infant with bilious vomiting should not be discharged without evaluation of the ligament of Treitz, typically by radiographic upper GI series.
Immediate surgical evaluation or consultation is indicated for all infants with bilious vomiting, as delayed presentation or surgical correction results in increased morbidity and mortality

Key Factors

Exam

Diagnosis:

1st Tests To Order

Other Tests to Consider

Treatment:

DDx Vomiting in Pediatrics
TE Fistula /
Esophageal Atresia
GERD Pyloric Stenosis Duodenal Atresia Malrotation/
Volvulus
Necrotizing  Enterocolitis Intussusception Intersitnal Atresia
- Frothing, Bubbling
- Excessive salivation
- Chocking w/ 1st feed
- 20-30 miin after feeding
- Spitting up
- Present since birth
 
- Non-Bilious
- Projectile
- NOT present at birth
- Hungry baby
- HypoChloremic, Hypokalemic
- Metabolic Alkalosis
- Present AT BIRTH
- Vomit with feed
- BILIOUS
- Associated w/ Down Syndrome
 
-Bilious vomiting
-infant age <1 year
-dark blood in diaper
-abdominal distension
- Pre-term Baby
- Intramural Air
- Distended Abdomne
- (+) Blood in stool
-age 6 to 12 months
-male gender
-abdominal pain
-vomiting
-lethargy/irritability
-blood per rectum/currant jelly stool
-hypovolemic shock

 

MC site: Jejunal Atresia
- Bilious vomit at birth
- Distended Abdomen
  Dx:
- 24 hr pH monitoring
- Reflux scan
Dx:
US
Dx:
- Abd XR = Double Bubble
Dx:
-
Upper GI contrast series
-CT abdomen (WITH oral and IV contrast)
-Abdominal plain films
-CBC, ABG
-
Ultrasound
- lower GI contrast series
Dx:
- ABD XR = pneumonitis intestinalis or free air.
Dx:
- abdominal plain-film x-ray
-ultrasound
- diagnostic enema
- CT Abd
DX:
- Abd XR = Triple Bubble
  Tx:
Reglan 0.2mg/kg/dose

Ranitadine 10mg/kg/day
Tx:
Surgery
Tx:
- NG, Surgery
Tx:
Surgery
Tx:
- Bowel rest (NPO)
-
cefotaxime
- Pediatric surgeon Consult
Tx:
-IV Fluid
-Barium enema
-ABx
-Surgery