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Malrotation of the intestine in children
E G Ford1, M O Senac, M S Srikanth
1Division of Pediatric Surgery, Children Hospital of Los Angeles, California.
Insights
Intestinal malrotation in children can lead to serious complications. Surgical correction has significantly improved outcomes, with mortality rates dropping from 23% to 2.9% over 50 years.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Intestinal malrotation is a congenital condition that can cause life-threatening complications like volvulus and intestinal necrosis.
- Early diagnosis and surgical intervention are crucial for improving outcomes in affected infants and children.
Purpose of the Study:
- To analyze the surgical management and outcomes of intestinal malrotation in a pediatric population.
- To evaluate the trends in mortality rates for intestinal malrotation over a 50-year period.
Main Methods:
- Retrospective review of 102 children treated for intestinal malrotation between 1977 and 1987.
- Analysis of patient demographics, gestational age, presenting symptoms, co-existing congenital anomalies, diagnostic methods, surgical procedures, and complications.
- Comparison of mortality rates with historical data from 1937 to 1987.
Main Results:
- The study included 102 children, with 65% being infants. Bilious emesis and intestinal obstruction were the most common symptoms.
- Congenital anomalies were present in 70% of patients. Surgical correction involved malrotation repair, appendectomy, and anomaly correction.
- The mortality rate for intestinal malrotation decreased significantly from 23% in the earlier period to 2.9% in the 1977-1987 cohort.
Conclusions:
- Surgical correction of intestinal malrotation is effective in reducing mortality.
- Improved diagnostic and surgical techniques have contributed to better outcomes in pediatric patients with intestinal malrotation.
- The study highlights a significant advancement in the management of intestinal malrotation, emphasizing the importance of timely surgical intervention.
Abstract:
Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7). Seventy patients had congenital anomalies (50 single, 20 multiple). Diagnostic evaluations included 56 upper gastrointestinal series and 27 barium enemas. Each patient underwent correction of malrotation and appendectomy, and correction of congenital anomalies (omphalocele-9, gastroschisis-6, diaphragmatic hernia-7). Complications included short gut (2), sepsis (5), feeding difficulties (2), pneumonia (3), small bowel obstruction (2), and other (15). Nine patients (8.8%) died (trisomy 18-1, trisomy 13-1, intestinal necrosis-3, hepatic failure-1, prematurity-1, other sepsis-2). Two hundred sixteen children with intestinal malrotation have been treated from 1937 to 1987. Mortality rate has improved from 23% to 2.9%.