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Intestinal malrotation

Última revisão: 23 Sep 2025
Última atualização: 27 Aug 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • bilious vomiting
  • abdominal pain
Detalhes completos

Outros fatores diagnósticos

  • infant age <1 year
  • normal abdominal exam
  • abdominal distension
  • abdominal tenderness
  • tachycardia with hypertension
  • tachycardia with hypotension
  • tachypnea
  • weight loss
  • dark blood in diaper
Detalhes completos

Fatores de risco

  • embryologic abnormality
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • upper gastrointestinal contrast series
  • abdominal plain films
Detalhes completos

Investigações a serem consideradas

  • ultrasound
  • lower gastrointestinal (GI) contrast series
  • CT abdomen (with oral and intravenous contrast)
  • ABG (including lactate)
  • Coagulation studies, type and screen, or cross-match
  • Blood chemistries
  • CBC
  • CRP
Detalhes completos

Algoritmo de tratamento

Inicial

obstruction with ischemia

AGUDA

obstruction without ischemia

intermittent or partial volvulus or obstructing Ladd bands

questionable malrotation or asymptomatic finding

Colaboradores

Autores

Michael Stanton, MB BS, MD, FRCS (Paed Surg)

Consultant Paediatric Surgeon and Honorary Senior Lecturer

Department of Paediatric Surgery

University Hospital Southampton

Southampton

UK

Declarações

MS declares that he has no competing interests.

Agradecimentos

Dr Michael Stanton would like to gratefully acknowledge Dr Stephen Shew, Dr S.D. St Peter, Dr Fizan Abdullah, and Dr Omar Karim, previous contributors to this topic.

Declarações

SS is the author of two references cited in this topic. SDSP is the co-author of one reference cited in this topic. FA and OK declared that they had no competing interests.

Revisores

Casey M. Calkins, MD

Assistant Professor of Pediatric Surgery

The Medical College of Wisconsin

Children's Hospital and Health System

Milwaukee

WI

Declarações

CC declares that he has no competing interests.

Steve Rothenberg, MD

Chief of Pediatric Surgery

Chairman Department of Pediatrics

The Rocky Mountain Hospital for Children at Presbyterian/St. Luke's

Denver

CO

Declarações

SR declares that he has no competing interests.

KuoJen Tsao, MD

Assistant Professor

Department of Pediatric Surgery

University of Texas Health Science Center at Houston

Houston

TX

利益声明

KT declares that he has no competing interests.

Eric Nicholls, MD

Consultant Paediatric Surgeon

Paediatric Surgery

St George's Hospital

London

UK

利益声明

EN declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Shew SB. Surgical concerns in malrotation and midgut volvulus. Pediatr Radiol. 2009;39(suppl 2):S167-71. 摘要

Expert Panel on Pediatric Imaging, Alazraki AL, Rigsby CK, et al. ACR appropriateness criteria® vomiting in infants. J Am Coll Radiol. 2020 Nov;17(11s):S505-15.全文  摘要

Graziano K, Islam S, Dasgupta R, et al. Asymptomatic malrotation: diagnosis and surgical management: an American Pediatric Surgical Association outcomes and evidence based practice committee systematic review. J Pediatr Surg. 2015 Oct;50(10):1783-90. 摘要

Ooms N, Matthyssens LE, Draaisma JM, et al. Laparoscopic treatment of intestinal malrotation in children. Eur J Pediatr Surg. 2016 Aug;26(4):376-81.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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