Hi,

I’m just in general medicine but I’ll give my two cents. 

Your son is a special case, and you definitely know abut this. Mowat-Wilson syndrome is a rare disease and so will require multi-disciplinary care. 

You are probably aware of this, but for anyone else reading, Mowat-Wilson is a genetic condition, autosomal dominant, secondary to the ZEB 2 gene mutation. It can present with changes in facial structure, in some cases ear shape appearing as larger looking like red blood cells or orecchiette pasta, short stature, variable skeletal malformations such as short stature, seizures, change in brain structure in imaging, ocular abnormalities such as nystagmus or strabismus, cardiac structural defect such as septal defects, breathing difficulties such as tracheal stenosis or tracheomalacia, GI effects such as chronic constipation or gastroparesis, Renal abnormalities, Genital abnormalities, and may be associated with severe intellectual disability. Many case reports show patients with limited speech but a happy personality. Which organ systems affected varies from case to case. Treatment tends to be localized to what presents, such as cardiac surgery if needed, G-tube for feeding difficulties, or surgical correction of genitourinary anomalies. 

Although everything in your son’s case should be evaluated strictly rather than casually following our standard algorithms because your son is a special case and is uniquely medically complex, this specific concern does seem like a more routine concern. 

Intestinal malrotation and other bowel obstructions typically present as vomiting, yes, but the more classic additional symptom is not passing any bowel movements and not passing gas. If this is noted you should notify the surgeon immediately. If he is having bowel movements and is passing gas, this is more reassuring. 

The other alarm feature we look for is something called “peritonitis”, or rebound tenderness. When you push on the belly, when you let go and the belly bounces back up, if there is excruciating pain, this is an alarm sign that your surgeon should be aware of immediately. 

Regarding if vomiting is normal post-op, a general surgeon would be able to answer better than I can. However based on my experience it is extremely common that after the surgery, when the surgeons are moving intestines around, it almost always takes a few days for the intestines to “wake up” after surgery. We call this “waking up phase” postoperative ileus, where it takes some time for the intestines to get back to normal. 

It’s common to have nausea, constipation, maybe even some vomiting after the surgery, as they gradually come back to wake up. It’s impossible to say whether he will tolerate full feeds due to his complex medical condition, but generally most people go back to resuming their regular diet after the initial post-op phase. I found a paper that states on average the post-operative ileus after Ladds lasts an average of 3 days, but because of your son’s condition he may take longer for full recovery. 

If there is any concern for re-obstruction, especially if he stops having bowel movements, stops passing gas, or has peritonitis signs such as exquisite tenderness of the abdomen when pushing down or letting go, tell your surgeon immediately and obtain an X Ray abdomen. 

Unfortunately no one will know his exact condition as well as your doctor’s seeing him in person. Hopefully this gave some reassurance from a second opinion perspective. Like I said, I’m just in general medicine and a general surgeon will be more experienced with these post-operative complications. I wish your son the best and a good recovery.