Does your little one keep having stomach problems? Could this be intestinal malrotation?

Does your little one cry all the time because of a stomachache? Does he feel like he's full? Does he sometimes vomit green vomit? As a mother or father, it's normal to feel very worried at times like these. While we often think that these are just normal stomachaches, sometimes there may be a reason behind this that we should be a little more concerned about. So, one condition that we should definitely be aware of is intestinal torsion, or in medical terms, `(Malrotation)`.

Simply put, what is intestinal malrotation?

This may sound like a complicated word, but it's actually quite simple to understand. `Malrotation` is a congenital condition . That is, it occurs while the baby is still in the womb.

Think about it, when the baby's body parts are forming, the intestines are formed first, and then they need to coil up nicely and fit into their proper places inside the belly. This is what usually happens.

However, in the case of `Malrotation`, the intestines do not twist properly, but are positioned incorrectly. To be precise, the intestines are not positioned properly inside the abdomen. Due to this, the intestines are not properly attached to the abdominal wall. This is what we call `Malrotation`. This is not due to any fault on the part of the child or the parents.

What is the dangerous condition called 'Volvulus'?

When talking about `Malrotation`, the other most dangerous complication we need to know is `Volvulus`. This is the main risk of `Malrotation`. Simply put, this means that the intestines twist and become entangled .

Think about a water pipe. What happens if the pipe becomes bent and twisted in a loop at one point? The water flow is blocked, right? That's what happens here too.

Malrotation is a condition where the intestines are not properly positioned inside the abdomen, so they can easily become tangled together. When this happens, two main problems occur:

1. Bowel obstruction: The movement of digested food through the intestines is completely blocked. This is called ``Bowel obstruction``.

2. Blood flow interruption: What's even more dangerous is that the blood vessels that supply blood to the intestine also get caught in this twisting. Then, that part of the intestine doesn't get enough blood, and that part starts to die.

This condition, called `Volvulus`, is a surgical emergency . If left untreated, the bowel can die, become perforated, and develop serious, life-threatening complications such as `Bowel perforation`, infection of the abdomen (peritonitis), blood poisoning (sepsis), and shock.

What are the symptoms of this condition? How do we recognize it?

Some children may not show any symptoms when they have only `malrotation`. However, symptoms appear suddenly when `volvulus` occurs. These symptoms are most common in children under 5 years of age, especially within the first month of life.

Let's see how these characteristics differ for babies and older children.

Characteristics of children over one year old

Symptoms in older children may be slightly different. Some studies have shown that children over 2 years of age are less likely to vomit green. They usually have recurrent stomach pain and vomit that is a normal color.

Why is this happening? What is the reason?

In fact, researchers still don't know the exact cause of this. All we know is that it's a congenital condition. The intestines of a fetus begin to form around the 10th week of pregnancy. So for some reason during this process, these intestines don't form properly. Research is still ongoing to find the exact cause.

How do doctors diagnose this condition?

If your child has the above symptoms, when you go to see a doctor, he will first examine the child carefully. He will feel the child's abdomen and check for swelling or pain.

Then, to confirm the diagnosis, several tests are ordered that can take pictures of the inside of the abdomen. The main ones are:

• Abdominal ultrasound scan
• X-rays using a fluorescent substance (contrast)

These tests can clearly see the position of the intestines and whether there is any obstruction in the food pipe.

How is it treated? Is surgery necessary?

Yes, children with `Malrotation` usually have to undergo surgery. The main goal of this surgery is to untwist the twisted intestines and reposition them in the correct positions inside the abdomen.

There are two main surgical techniques used for this:

1. Ladd's procedure: This is the most commonly used procedure. In this procedure, the surgeon cuts away the abnormal bands of tissue that are holding the intestines together. The twisted intestines are then untied and repositioned. This procedure can be done as an open surgery or laparoscopically. However, there is a very rare risk of the intestines twisting again (recurrent volvulus) after this procedure.

2. Kareem's procedure: This is a relatively new procedure. In this procedure, the intestines are completely rotated into the correct position and secured to the abdominal wall. This is thought to reduce the risk of re-twisting the intestines.

The medical team will discuss with you the most appropriate surgical procedure for your child's condition.

Sometimes, depending on the extent of damage to the intestine, additional measures may need to be taken in addition to surgery.

• Removal of a damaged part of the intestine.
• A temporary or permanent opening in the abdomen to allow stool to pass through (Colostomy).
• Removal of the appendix (because the position of the intestines changes, making it difficult to diagnose appendicitis in the future).

When should we see a doctor? When should we go to the ETU?

This is the most important part. If you have the slightest doubt about something with your baby, don't wait and say, "This will just get better." Especially in situations like `Malrotation`, early intervention can save the baby's life.

When to see your doctor:

If your child has the following symptoms, see a pediatrician.

• Recurrent vomiting (even if it is normal in color).
• If you always talk about a stomach ache.
• If the child is not gaining weight properly.

Remember, these symptoms are not always caused by `Malrotation`. It could also be due to another condition, such as `Reflux`. Whatever the cause, it is best to get checked out by a doctor.

When to go to the Emergency Treatment Unit (ETU) immediately:

If any of the following symptoms are present, take the child to the nearest hospital Emergency Department (ETU) without delay . These may be dangerous signs of a condition called `Volvulus`.

Can't this situation be prevented?

Since `Malrotation` is a congenital condition and the exact cause is unknown, there is no way to prevent it. Also, the `Volvulus` condition that results from it cannot be prevented.

However, the best thing we can do is to act as soon as symptoms appear . This can greatly reduce the risk of serious complications.

Malrotation, Volvulus, Intestinal torsion, Intestinal entanglement, Pediatrics, Green vomit, Stomach upset in children, Ladd's procedure, Emergency surgery