Intussusception and intestinal malrotation in infants: Waugh's syndrome

Abstract

The position of the duodenojejunal flexure was determined in 37 out of a group of 49 consecutive infants presenting with intussusception. The flexure was in a normal position in 19, at the midline in 3, and in an abnormal position in 15. The caecum was unfixed in all of the 41 infants subjected to operation. It is concluded that lack of normal rotation and fixation of the intestine is an important factor in the aetiology of idiopathic intussusception of infants.

Are Intussusceptions More Common and Severe in Malrotation? - Waugh Syndrome

“…The association of malrotation and intussusception is referred to as Waugh syndrome by Brereton et al [2] after George E Waugh, who first described the association in a report in 1911 [4]. It has been postulated that the presence of mobile ascending colon in cases of malrotation, predisposes for prolapse of terminal ileum and proximal colon into non fixed distal colon [5].…”

“…Although, both USG and X ray with contrast can diagnose lack of normal rotation and fixation of the intestine during non-operative means of reduction, it is often overlooked and only few series have reported its incidence [2]. This can have disastrous consequences and child can present later with complications of malrotation [10].…”

“…The incidence of malrotation is 1 in 500 live births, [1] with bilious vomiting and sometimes, acute abdomen as prime mode of clinical presentation. Although literature reports of intussusception having associated lack of normal rotation and fixation of the intestine(malrotation), in as high as 40% of cases, [2] this combination is not often reported [3]. We want to report this often overlooked clinical combination, more so in era of conservative management of intussusception, which can have profound effect on mortality and morbidity of child.…”

Association of Waugh Syndrome with Intestinal Volvulus in an Infant

“…Intussusception and intestinal malrotation is a rare association, named Waugh's syndrome by Brereton et al [1]. These authors described, in a prospective study, a high incidence of malrotation in patients with intussusception.…”

“…However, the simultaneous occurrence of intestinal invagination and malrotation (Waugh's syndrome), and bowel volvulus is very rare [1]. Successful outcome of this clinical condition depends on prompt diagnosis and timely surgical intervention, to avoid serious complications such as vascular compromise of the gut due to associated volvulus.…”