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[Bilious vomiting due to malrotation, also in older children]
M Bruijn1, B H Wolf, A M Smets
1Kinderchirurgisch Centrum Amsterdam/Universiteit van Amsterdam, locatie Emma Kinderziekenhuis AMC, Postbus 22.660, 1100 DD Amsterdam.
Nederlands Tijdschrift Voor Geneeskunde
|April 13, 2004
Summary
Delayed diagnosis of intestinal malrotation in children can lead to serious complications. Prompt investigation of bilious vomiting, using upper gastrointestinal contrast studies, is crucial for early detection and surgical treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intestinal malrotation is a congenital anomaly that can lead to significant morbidity if not diagnosed and treated promptly.
- While often diagnosed in infancy, malrotation can present later in childhood with varied symptoms.
Observation:
- This study reviewed 12 pediatric patients operated for intestinal malrotation after one year of age between 1989 and 2002.
- The mean age at operation was 5 years, with presenting symptoms including bilious vomiting and abdominal pain.
- A history of neonatal bilious vomiting was noted in four patients, and nine had prior hospital admissions for abdominal complaints.
Findings:
- The most sensitive imaging technique for diagnosing malrotation was an upper gastrointestinal contrast study.
- Surgical intervention led to full recovery in all treated children.
- Malrotation with intermittent volvulus can manifest as recurrent abdominal pain and vomiting in children.
Implications:
- Bilious vomiting at any age warrants thorough investigation to rule out malrotation or other obstructive causes.
- Early diagnosis and surgical correction of intestinal malrotation are essential for favorable outcomes in pediatric patients.
- Upper gastrointestinal contrast studies are recommended for suspected cases of intestinal malrotation.
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