Diagnosis and treatment of intestinal malrotation in infants and children

This algorithm is intended for all infants and children with findings suggestive of intestinal malrotation. Malrotation presents within the first year of life in the majority of cases but should be suspected at any age in patients with clinical findings that could be consistent with malrotation.

US: ultrasound; UGI: upper gastrointestinal series.

* Refer to UpToDate topics on rapid recognition and treatment of septic shock in children.

¶ Examples of appropriate antibiotic choices include piperacillin-tazobactam or ceftriaxone and metronidazole. For dosing, refer to Lexicomp Drug Information monographs.

Δ Distention may not be present in patients with acute volvulus, especially neonates and young infants.

◊ Radiologists performing abdominal US and/or UGI with oral contrast should have experience with the performance and interpretation of these studies in children. US is used as the initial examination for screening and diagnosis of volvulus in many institutions. However, if US is negative or indeterminate for malrotation, a limited UGI should be performed. Obtaining a limited UGI as the initial study instead of an abdominal US is an acceptable alternative approach.

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Diagnosis and treatment of intestinal malrotation in infants and children