Intestinal malrotation: experience in Zaria, Nigeria

This report retrospectively reviews the presentation, management and outcome in 14 patients with intestinal malrotation. There were 7 males and 7 females, with a median age of 4 months (range 5 days-22 years). Most neonates and infants presented with persistent or recurrent vomiting while older children had recurrent abdominal pain. Five patients (36%) including 2, < 1 year and 3 older children developed midgut volvulus. Malrotation was an incidental finding at laparotomy for unrelated conditions in 2 patients (14%). Overall, preoperative diagnosis was not made in any patient. Associated congenital anomalies were present in 3 (21%) patients. Treatment was by Ladd's procedure in 12 (86%) patients and caecopexy in 2 (14%) without recurrence of symptoms in any. One patient each developed wound infection and adhesive intestinal obstruction requiring relaparotomy respectively. Mortality was 2 (14%) from overwhelming infection and hypokalaemia following midgut volvulus. Children presenting with recurrent or persistent abdominal pain, vomiting or failure to thrive may well have malrotation and should be investigated promptly and the condition corrected to avoid midgut volvulus which is attended by significant morbidity and mortality.