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Clinical factors affecting mortality in children with malrotation of the intestine
A Messineo1, J H MacMillan, S B Palder
1Department of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
In children with intestinal malrotation, bowel necrosis, other serious abnormalities, and younger age significantly increase mortality risk. Early surgery timing did not impact survival rates in this study.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Clinical Statistics
Background:
- Intestinal malrotation is a congenital condition requiring prompt surgical intervention.
- Symptoms can range from duodenal obstruction to midgut volvulus, with varying prognoses.
- Identifying mortality risk factors is crucial for improving outcomes in affected children.
Purpose of the Study:
- To identify factors associated with increased mortality in children with symptomatic intestinal malrotation.
- To analyze the impact of age, associated abnormalities, surgical delay, and bowel necrosis on survival.
Main Methods:
- Retrospective statistical analysis of 182 children undergoing laparotomy for intestinal malrotation between 1964 and 1989.
- Patients were categorized into three groups based on diagnosis: duodenal obstruction, midgut volvulus without necrosis, and midgut volvulus with necrosis.
- Statistical evaluation of mortality risk factors including age, comorbidities, and time to surgery.
Main Results:
- Mortality was significantly higher in children with bowel necrosis (Group III) compared to those without (Groups I and II).
- Factors independently associated with increased mortality were the presence of necrosis (P < .0001), other serious abnormalities (P = .0008), and younger age (P = .0084).
- Time from symptom onset to surgery was not a statistically significant predictor of mortality. Survival probability in Group III decreased significantly with increasing percentage of bowel resected.
Conclusions:
- Bowel necrosis, co-existing serious abnormalities, and young age are critical determinants of mortality in pediatric intestinal malrotation.
- While surgical timing was not significant, the extent of bowel necrosis heavily influences survival.
- Management strategies should prioritize early recognition and intervention, especially in neonates and infants presenting with concerning signs.
Abstract:
In children with symptoms secondary to malrotation of the intestine, a retrospective statistical study was undertaken to identify factors associated with an increased risk of mortality. Between 1964 and 1989, laparatomy was performed on 182 children. For study purposes, the children were divided into three groups. Group I included 71 patients with an obstruction only in the duodenum. The remaining 111 children, all of whom had midgut volvulus, were further divided; those without gut necrosis (79) into group II, and those with necrosis (32) into group III. One child each died in groups I and II, and 15 in group III. In all children we evaluated the relationship between mortality and age at presentation, presence of associated serious abnormalities, time from onset of symptoms to surgery, and the presence of necrotic bowel. For group III, we considered the influence of percentage of bowel resected on mortality. In these 182 children the factors associated with an increased risk of mortality were presence of necrosis (P < .0001), presence of other abnormalities (P = .0008), and younger age (P = .0084). Time from onset of symptoms to surgery was not associated with statistically increased risk of mortality. The 1% mortality noted in children without intestinal necrosis (group I and II) was related to associated abnormality. For group III the estimated probability of survival ranged from .999 for patients with 10% of intestinal necrosis to .351 for whose with 75% of intestinal necrosis, assuming the best prognostic conditions (patient older than 3 months with no associated serious abnormalities).