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Malrotation (Complications (Volvulus, Ischemic bowel, Obstruction,…
Malrotation
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Diagnosis
Examination
Abdo exam
Tenderness oto palpation
(peritonitis, ischemic bowel)
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Investigation
Bloods
FBC, U+E, LFT,
G+S, crossmatch
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History
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POH
Bloods, scans, growth, gestation,
delivery, weight, complicatioons
FH
GIT conditions, malrotations
PC/HPC
Bilious green vomiting,
tender abdomen, PR bleeding
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Epidemiology
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Presents first few days of life,
but can present later
Pathophysiology
Defect
During bowel rotation, mesentery does not
become fixed at DJ flexure or ileocaecal region
Base is shorter than normal
Ladd bands form (peritoneal bands)
Mechanism
Predisposed to volvulus, with obstruction
that may compromise blood supply
causing ischemic bowel
Management
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Definitive
Medical
Fluids
Indication: dehydration
Eg. NaCl, Hartmans
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Surgical
Laparotomy
Indication: ASAP
MOA: untwists volvulus, mobilses duodenum,
placed bowel in non-rotated position (not corrected;
DJ stays on right and appendix on left); appendix removed to avoid confusion incase appenidicitis occurs
Conservative
Information. advice, support
Admit to hospital
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