Defusing the intra-abdominal ticking bomb: intestinal malrotation in children.

CMAJ 2000;162(9):1315-7 The case A 6-month-old girl presents to her pediatrician with lethargy; she has been vomiting and the vomit is bile stained. She is admitted to hospital for tests. Plain radiographs of the abdomen and barium enema examination are normal. Results of an upper gastrointestinal (GI) study are suspicious for, but not diagnostic of, intestinal malrotation. The patient improves quickly and is discharged the following day. Over the next 2 months she continues to have similar short-lived episodes lasting a few hours, for which she is seen in the emergency department by on-call physicians. Her pediatrician initiates investigations to rule out an endocrine cause of the vomiting, when she has to be readmitted to hospital because of a severe episode. On this occasion, the girl’s condition rapidly deteriorates and, despite active resuscitation during a barium enema examination to rule out intussusception, she dies. Post-mortem examination shows midgut infarction due to malrotation-associated volvulus with peritonitis.