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Persistent gastrointestinal symptoms after correction of malrotation
S P Devane1, R Coombes, V V Smith
1Institute of Child Health, University of London.
Insights
Children experiencing persistent gastrointestinal issues after intestinal malrotation surgery often have underlying motor function defects. This suggests intrinsic enteric nervous system problems may contribute to malrotation itself.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Intestinal malrotation is a congenital condition requiring surgical correction.
- Post-surgical complications include persistent vomiting, diarrhea, and feeding intolerance.
- Intestinal malrotation is frequently associated with chronic idiopathic intestinal pseudo-obstruction.
Purpose of the Study:
- To investigate small intestine motor activity in children with persistent symptoms post-intestinal malrotation surgery.
- To determine if motor abnormalities similar to neuropathic pseudo-obstruction are present.
Main Methods:
- Studied eight children with persistent vomiting, feeding intolerance, or severe diarrhea after surgical correction of intestinal malrotation.
- Assessed small intestine motor activity during fasting.
Main Results:
- Seven of the eight patients exhibited abnormal small intestine motor function.
- The observed motor abnormalities resembled those seen in neuropathic pseudo-obstruction.
Conclusions:
- Persistent symptoms after intestinal malrotation surgery are linked to motility disturbances.
- These disturbances appear to stem from defects in intrinsic enteric innervation.
- Intrinsic enteric innervation defects may play a role in the etiology of intestinal malrotation.
Abstract:
Persistent vomiting, diarrhoea, or intolerance of feeding, are well recognised problems in children after surgical correction of intestinal malrotation. Conversely, intestinal malrotation is a common accompaniment of chronic idiopathic intestinal pseudo-obstruction. We investigated motor activity of the small intestine during fasting in eight children who had persistent vomiting, intolerance of full enteral feeding, or severe diarrhoea after surgical correction of intestinal malrotation. Abnormality of motor function similar to that found in neuropathic pseudo-obstruction was found in seven of the eight patients. Persistence of symptoms after surgical correction of a malrotation is associated with a motility disturbance which seems to be due to a defect of intrinsic enteric innervation. Such a defect may be important in the aetiology of the malrotation.