Malrotation of the intestines in children: The effect of age on presentation and therapy

Powell, David; Othersen, H. Biemann; Smith, C. Daniel

doi:10.1016/s0022-3468(89)80535-4

Cited by 156 publications

(98 citation statements)

References 14 publications

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“…The highest risk of intestinal torsion was noted accordingly by most authors among newborns and infants affected by malrotation. In children older than 1 year of age this risk was reported as much lower, with a maximum of 14% (5,16,18). Spigland et al, analyzing clinical aspects of malrotation in older children, found midgut volvulus in 65% of cases and emphasized that a patient's age should not be regarded as factor when excluding a complicated course of malrotation (19) The authors of the presented paper reported intestinal torsion in 2 of five older children, which seems to confirm the aforementioned statement.…”

Section: Discussionsupporting

confidence: 80%

Clinical Spectrum of Malrotation in Children

Bagłaj¹,

Patkowski²,

Czernik³

et al. 2007

Polish Journal of Surgery

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The aim of the study. Retrospective analysis of diagnosis, surgical management and final outcome of malrotation in children. Material and methods. Clinical charts, operative notes and imaging studies of all children operated on for malrotation in years 1985-2005 were studied. Children in whom malrotation was diagnosed incidentally during an operation performed because of other indications were excluded. A detailed analysis of the presentation, signs and symptoms, clinical course, and diagnostic modalities used in affected patients was carried out. Anatomical variants of malrotation and their operative management were evaluated as well. Results. In the period from 1985 to 2005 forty children with malrotation were treated. There were 25 neonates, 10 infants and 5 children older than 1 year of age. Thirty-five children were referred directly as inpatients from other hospitals. An acute or urgent clinical presentation was noted in 32 children, while in 8 patients as the presentation was subacute or chronic. In all children bile-stained vomiting was the predominant sign. In 21 children, ileus was the referral diagnosis. Only 5 children were admitted with an established diagnosis of malrotation. In six cases duodenal atresia was suspected. Delay in diagnosis of congential intestinal anomaly was identified in 15 children. In five newborns, the initial diagnosis was enterocolitis. Four other patients, including one infant and three older children, were admitted to the pediatric departments several times before receiving the final diagnosis. In 18 children, the only pre-operative imaging was abdominal plain X-ray. In 22 patients, contrast studies were performed as well. All children underwent operative management. Ladd's syndrome was diagnosed in 16 patients, and in another 7 children was associated with small bowel torsion. Isolated small bowel torsion was noted in 7 patients. In 6 patients, midgut volvulus with strangulation was found intraoperatively. Two children with typical anatomical features of non-rotation presented with recurrent episodes of ileus. In single cases, mesocolic internal hernia and sigmoid torsion were noted. 5 children died postoperatively, four of whom had midgut volvulus with massive small bowel necrosis. Conclusions. Malrotation is a rare congenital anomaly that can present with a wide anatomical and clinical spectrum but should be considered in the differential diagnosis for all children, regardless of age, manifesting with bile-stained vomiting. Suspicion of malrotation seems to be an obvious indication for referral to a tertiary pediatric surgical department where necessary imaging should be undertaken with the participation of an experienced radiologist. Regardless of its clinical presentation, malrotation should be considered an unequivocal indication for surgical treatment due to risk of midgut volvulus with its serious sequelae.

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Section: Discussionsupporting

confidence: 80%

Clinical Spectrum of Malrotation in Children

Bagłaj¹,

Patkowski²,

Czernik³

et al. 2007

Polish Journal of Surgery

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“…Similar reports were published previously. 6 The incidence of duodenal atresia roughly varies between 1:6000 to 1:10000 of the live births as per the literature. 7 There is no genetic anomaly or gene defect identified to be associated with duodenal atresia so far.…”

Section: Discussionmentioning

confidence: 94%

Clinical profile and predictors of outcome in congenital duodenal obstruction

Chandrasekaran

Asokaraju

2017

Int Surg J

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Background: Congenital duodenal obstruction is a broad term that refers to a variety of disorders like duodenal atresia, duodenal stenosis, annular pancreas, duodenal membrane and preduodenal portal vein. The aim of this study was to analyse in detail the entire clinical profile of duodenal obstruction and to study the short-term outcome.Methods: A prospective descriptive study was conducted in the Department of Paediatric Surgery, Institute of child Health and Hospital for Children, Egmore, Chennai, among all babies with suspected duodenal obstruction based on clinical symptoms and subsequently proven by surgery from September 2013 to January 2015. Fifty babies were selected for this study based on the eligibity criteria.Results: Upper gastrointestinal contrast radiography is the gold standard investigation in diagnosing duodenal membrane with a hole. The type of surgery such as the duodenoplasty, duodenoduodenostomy or duodenojejunal anastomosis did not affect the post-op outcome.Conclusions: Long term follow up is warranted to know the actual incidence of requirement for redo procedure for feed intolerance. The presence of coexisting Down’s syndrome and congenital cardiac lesions increases the mortality rate in these children.

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“…8 morbidity and mortality to a large extent is in patients of malrotation who were diagnosed after onset of volvulus. 10 Advances in neonatal surgery and postoperative neonatal care especially total parenteral nutrition have significantly improved the outcome in babies with midgut volvulus. For neonates presenting with extensive gangrene due to midgut volvulus the outcome is very poor due to short bowel syndrome and intestinal failure.…”

Section: Discussionmentioning

confidence: 99%

Neonatal small bowel obstruction due to malrotation: a clinical study

et al. 2017

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Background:This study was done at Niloufer hospital and institute of child health, Hyderabad with an aim of evaluating the clinical presentation, diagnostic evaluation, management and outcome of malrotation of intestines in the neonates.Methods: Cases of neonatal small intestinal obstruction due to malrotation presenting to the Department of Pediatric Surgery, Niloufer hospital over a period of two years were evaluated.Results: A total of 38 newborns presented to our department with intestinal obstruction due to malrotation. 3/38 patients presented with extensive gangrene of midgut. 4/38 patients died during the course of treatment.Conclusions: Malrotation is a relatively common cause of neonatal small bowel obstruction. A high index of suspicion is needed in neonates presenting with bilious vomiting. Early laparotomy prevents fatal complication of extensive gangrene due to midgut volvulus.

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Malrotation of the intestines in children: The effect of age on presentation and therapy

Cited by 156 publications

References 14 publications

Clinical Spectrum of Malrotation in Children

Clinical Spectrum of Malrotation in Children

Clinical profile and predictors of outcome in congenital duodenal obstruction

Neonatal small bowel obstruction due to malrotation: a clinical study

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