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Malrotation Surgery


Question

Our 2 ½ month old daughter has been diagnosed with having "modified malrotation." The doctor said it is not "a normal malrotation as the organs aren't shifted around." There is no blockage and the pediatric surgeon is saying surgery is elective. What factors should we consider at this point to decide whether or not to have surgery? If the doctor does the surgery, he also wants to remove her appendix. Is that typical? The doctor is saying that if he does go ahead with surgery, he would not consider giving her anything stronger than Tylenol, because anything stronger would interfere with her further development. His opinion is that crying is good; it promotes healing and develops the lungs, but we are concerned about having our daughter in post-operative pain. Can other pain medications cause developmental delays?

Answer of our experts

There are different severities of malrotation and a pediatric surgeon should be the one to decide if it should be fixed. I would not have an adult surgeon do such a small tyke and I would have it done in a children's hospital. Taking the appendix out is part of the operation-the idea is to scar down the gut so it can't twist on itself and cut off the blood supply and die

Pain medications don't cause developmental delays and are certainly used on small children. They do need to cry for their lungs, and don't usually need much for pain, but they do need something other than Tylenol

CP/ TK 7-13-10

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Recommendation(s)

Malrotation; the intestines (or viscera) are twisted

R29
Presentation of any abdominal symptoms in an individual with CdLS, irrespective of age, should prompt consideration of intestinal malrotation.
R30
Evaluation for the presence of intestinal malrotation needs to be discussed and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.

Recommendation(s)

Pain and Behaviour

R18
As pain can easily remain unrecognised in a child with CdLS, all care providers should be aware of the different manifestations and the possible sources of pain. Specific tools to assess pain are recommended.

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