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Malrotation and volvulus in infancy and childhood

A J W Millar1, H Rode, S Cywes

  • 1Department of Paediatric Surgery, School of Child and Adolescent Health, University of Cape Town and Red Cross Children's Hospital, Rondesbosch, South Africa.

Seminars in Pediatric Surgery
|December 5, 2003
PubMed

Insights

Malrotation and midgut volvulus in children present diagnostic challenges. Early recognition of vomiting and pain is crucial, as imaging can be inconclusive, necessitating surgical exploration.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery

Background:

  • Intestinal malrotation and midgut volvulus are critical surgical emergencies in infants and children.
  • These conditions can lead to significant morbidity and mortality if not promptly diagnosed and treated.

Purpose of the Study:

  • To review the diagnosis, investigation, and management of malrotation and midgut volvulus in pediatric patients.
  • To emphasize the importance of clinical suspicion in diagnosing these conditions.

Main Methods:

  • Review of 138 patients from a published series and 82 additional cases.
  • Discussion of embryology, clinical presentation, diagnostic imaging, surgical approaches, and patient outcomes.

Main Results:

  • Vomiting, especially bile-stained, and abdominal pain are key symptoms.
  • Diagnosis can be challenging, with normal radiographs not excluding the condition.
  • Contrast studies (meal and follow-through) are highly diagnostic when interpreted correctly; ultrasound is less definitive.

Conclusions:

  • Malrotation with volvulus is a "time bomb" requiring high clinical suspicion.
  • Laparotomy or laparoscopy remains the definitive diagnostic and therapeutic approach.
  • Prompt surgical intervention is essential for favorable outcomes.

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