The Role of Nursing Assessment in Diagnosing Intestinal Malrotation: A Case Report

Intestinal malrotation is a congenital anomaly of the gastrointestinal tract that is most commonly diagnosed during the neonatal period. Delayed presentation beyond infancy is uncommon and may result in significant diagnostic challenges, particularly in children with complex genetic disorders. This case describes a 4-year-old girl with Edwards syndrome (Trisomy 18) whose atypical presentation of intestinal malrotation created a demanding clinical situation for the multidisciplinary healthcare team. The patient was admitted to the pediatric surgical department with coffee-ground vomiting and a one-week history of constipation. Due to severe developmental impairment and limited communication abilities associated with her genetic condition, the assessment of symptoms relied heavily on careful clinical observation. The nursing team played a crucial role in the diagnostic process through comprehensive assessment, including pain evaluation using the FLACC scale, continuous monitoring of vital signs, and detailed observation of the frequency and characteristics of emesis. These findings raised suspicion of a high-level intestinal obstruction and prompted further diagnostic investigations. Although the initial abdominal X-ray suggested a diaphragmatic hernia, surgical exploration revealed intestinal malrotation with volvulus consistent with Ladd’s syndrome. This case highlights the importance of advanced nursing assessment, clinical vigilance, and interdisciplinary collaboration in recognizing rare surgical emergencies and ensuring patient safety in children with significant communication barriers and complex healthcare needs.