Fetal malrotation with midgut volvulus: Prenatal diagnosis and planning

Hammond, J.D.; Gilley, Jamie; Beckman, Ross M.; Bulathsinghala, Marie; Keswani, Sonya S.; Davies, Jonathan Ivor; Mazziotti, Mark V.; Donepudi, Roopali; Belfort, Michael A.; King, A. J.; Ketwaroo, Pamela M.; Lee, Timothy C.

doi:10.1016/j.epsc.2023.102654

Cited by 1 publication

(1 citation statement)

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“…Upper gastrointestinal series (UGIs) remains the gold standard for diagnosing malrotation with or without volvulus ( 8 ). However, in recent years, ultrasound (US) has been used as the first-line modality for diagnosing malrotation with volvulus ( 9 ), even during prenatal screening ( 10 , 11 ). The treatment of malrotation with volvulus is challenging for emergency physicians and pediatric surgeons.…”

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confidence: 99%

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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BackgroundIntestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of malrotation in children.MethodsClinical data, imaging, operative findings, and early postoperative outcomes of 75 children with malrotation were retrospectively analyzed.ResultsThe mean age was 6.18 ± 4.93 days and 51.26 ± 70.13 months in the neonatal group (56 patients) and non-neonatal group (19 patients), respectively. Sixty-seven patients were under the age of 1 year at the time of diagnosis. The occurrence of bilious vomiting and jaundice was significantly higher in the neonatal group (89.29%) than that in the non-neonatal group (37.5%), p < 0.05 and p < 0.01, respectively. The incidence of abnormal ultrasound (US) findings was 97.30% and 100%, respectively, and the sensitivities of the upper gastrointestinal series were 84.21% and 87.5%, respectively. Sixty-six (88%) patients had midgut volvulus, including in utero volvulus (two patients) and irreversible intestinal ischemia (four patients). Most neonates (89.29%) underwent open Ladd's procedure with a shorter operative time (p < 0.01). Reoperation was performed for postoperative complications (four patients) or missed comorbidities (two patients).ConclusionsNon-bilious vomiting was the initial symptom in >10% of neonates and nearly 40% of non-neonates. This highlights the importance for emergency physicians and surgeons to be cautious about ruling out malrotation in patients with non-bilious vomiting. Utilizing US can obviate the need for contrast examinations owing to its higher diagnostic accuracy and rapid diagnosis and can be recommended as a first-line imaging technique. Additionally, open surgery is still an option for neonatal patients.

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