The identification and treatment of intestinal malrotation in older children

Dekonenko, Charlene; Sujka, Joseph; Weaver, Katrina L.; Sharp, Susan W.; Gonzalez, Katherine W.; Peter, Shawn D. St.

doi:10.1007/s00383-019-04454-9

Cited by 25 publications

(26 citation statements)

References 17 publications

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“…Intestinal obstruction caused by congenital bands or volvulus was the most common finding at surgery. Dekonenko et al also reported intestinal obstruction as the most common sequel of intestinal malrotation [26]. Intestinal obstruction may be acute like in volvulus or chronic like in chronic duodenal obstruction caused by congenital (Ladd's) bands.Incomplete fixation of the bowel (malrotation) may predispose to intussusception.…”

Section: Discussionmentioning

confidence: 98%

Intestinal Malrotation in Children: Experience of a Tertiary Care Hospital in a Developing Country

Emeka¹

2020

Janaki Med. Coll. J. Med. Sci.

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Background and Objectives: Intestinal malrotation is a congenital disorder resulting from abnormal rotation of the intestine during fetal development. The aim of this study was to evaluate our experience in the management of pediatric patients with intestinal malrotation. Material and Methods: This was a retrospective study of children aged 3 years and below who were treated for intestinal malrotation between January 2014 and December 2018 at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. Results: Sixty-one patients had laparotomy for intestinal malrotation during the study period. There was predominance of male neonates and the age range was 10 days to 3 years. Abdominal pain and upper gastrointestinal tract contrast study were the most common symptom and investigation respectively. Intestinal obstruction caused by congenital (Ladd’s) bands was the most common intraoperative finding and Ladd’s procedure was the most performed surgical procedure. Most patients did not develop any post-operative complications. However, surgical site infection was the most common complication following surgery. Mortality occurred in 8 (13.1%) patients. Conclusion: Intestinal malrotation symptoms occur mainly in male neonates and abdominal pain is a common and consistent symptom. Upper gastrointestinal contrast study is diagnostic. There are morbidity and mortality associated with treatment of intestinal malrotation.

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Section: Discussionmentioning

confidence: 98%

Intestinal Malrotation in Children: Experience of a Tertiary Care Hospital in a Developing Country

Emeka¹

2020

Janaki Med. Coll. J. Med. Sci.

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“…Adult presentation is rare and estimated to account for only 0.2–0.5% of cases [ 5 ]. The current literature suggests that presentation varies by age [ 4 , 6 , 7 ]. Malrotation in adults tends to either be found incidentally when a patient undergoes imaging or requires a laparotomy, or present as chronic, non-specific gastrointestinal symptoms such as intermittent crampy abdominal pain, bloating, weight loss, and nausea/vomiting.…”

Section: Discussionmentioning

confidence: 99%

A problem at any age: a case report of congenital malrotation with bowel ischemia in an 84-year-old

et al. 2022

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Background Malrotation with bowel ischemia is classically thought of as a disease of infants. However, the true prevalence of malrotation in both the pediatric and adult population is unknown due to the unclear number of asymptomatic patients. Case presentation A previously healthy 84-year-old man with no prior abdominal surgeries presented with an acute abdomen and was found on CT to have small bowel located in the right hemiabdomen and an abnormal SMA-SMV relationship suggestive of intestinal malrotation, as well as pneumatosis intestinalis. He underwent an exploratory laparotomy, where he was found to have a paraduodenal space which did not contain any bowel but was the likely source of an internal hernia. His duodenojejunal flexure was located to the right of the spinal column, the cecum in the left lower quadrant, a thick congenital band at the proximal jejunum, and multiple Ladd’s bands at the level of the duodenum. The bowel appeared viable and a Ladd’s procedure was performed. The patient had an uneventful post-operative course. Conclusions There is a lack of guidelines regarding screening for and management of asymptomatic malrotation in older children and adults. However, the traditional thinking is that asymptomatic malrotation diagnosed after two years of age poses minimal risk. This case illustrates the potential risk of an internal hernia in the setting of malrotation at any time during one’s lifetime.

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“…Along with other scattered publications, Ladd's procedure and increasing age reduced but did not prevent the risk of volvulus. 15 – 24 , 31 – 48 …”

Section: Discussionmentioning

confidence: 99%

Five Hundred Patients With Gut Malrotation

et al. 2021

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Objectives: Define clinical spectrum and long-term outcomes of gut malrotation. With new insights, an innovative procedure was introduced and predictive models were established. Methods: Over 30-years, 500 patients were managed at 2 institutions. Of these, 274 (55%) were children at time of diagnosis. At referral, 204 (41%) patients suffered midgut-loss and the remaining 296 (59%) had intact gut with a wide range of digestive symptoms. With midgut-loss, 189 (93%) patients underwent surgery with gut transplantation in 174 (92%) including 16 of 31 (16%) who had autologous gut reconstruction. Ladd's procedure was documented in 192 (38%) patients with recurrent or de novo volvulus in 41 (21%). For 80 patients with disabling gastrointestinal symptoms, gut malrotation correction (GMC) surgery “Kareem's procedure” was offered with completion of the 270° embryonic counterclockwise-rotation, reversal of vascular-inversion, and fixation of mesenteric-attachments. Concomitant colonic dysmotility was observed in 25 (31%) patients. Results: The cumulative risk of midgut-loss increased with volvulus, prematurity, gastroschisis, and intestinal atresia whereas reduced with Ladd's and increasing age. Transplant cumulative survival was 63% at 10-years and 54% at 20-years with best outcome among infants and liver-containing allografts. Autologous gut reconstruction achieved 78% and GMC had 100% 10-year survival. Ladd's was associated with 21% recurrent/de novo volvulus and worsening ( P > 0.05) of the preoperative National Institute of Health patient-reported outcomes measurement information system gastrointestinal symptom scales. GMC significantly ( P ≤ 0.001) improved all of the symptomatology domains with no technical complications or development of volvulus. GMC improved quality of life with restored nutritional autonomy ( P < 0.0001) and daily activities ( P < 0.0001). Conclusions: Gut malrotation is a clinicopathologic syndrome affecting all ages. The introduced herein definitive correction procedure is safe, effective, and easy to perform. Accordingly, the current standard of care practice should be redefined in this orphan population.

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The identification and treatment of intestinal malrotation in older children

Cited by 25 publications

References 17 publications

Intestinal Malrotation in Children: Experience of a Tertiary Care Hospital in a Developing Country

Intestinal Malrotation in Children: Experience of a Tertiary Care Hospital in a Developing Country

A problem at any age: a case report of congenital malrotation with bowel ischemia in an 84-year-old

Five Hundred Patients With Gut Malrotation

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