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[Midgut malrotation risk in abdominal wall defect].

A L Luis1, F Hernández, S Rivas

  • 1Departamento de Cirugía Pediátrica, Hospital Infantil La Paz, Madrid.

Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica
|October 27, 2004
PubMed
Summary

Undiagnosed midgut malrotation can complicate abdominal wall defect surgeries. Surgeons should consider malrotation in patients with later obstructive symptoms, as it often requires a Ladd procedure for definitive treatment.

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Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery

Background:

  • Midgut malrotation is a rare condition with low incidence but significant morbidity.
  • It can complicate high-morbidity clinical situations, including abdominal wall defects.
  • This study investigates complications arising from untreated malrotation in patients initially treated for abdominal wall defects.

Purpose of the Study:

  • To evaluate the incidence and outcomes of non-treated midgut malrotation in patients undergoing surgery for abdominal wall defects.
  • To identify complications associated with concurrent malrotation in this patient population.

Main Methods:

  • Retrospective review of patient charts from 1993-2002.
  • Analysis of initial surgical treatment, associated morbidities, and subsequent surgical interventions for abdominal wall defects.

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  • Focus on patients who developed complications attributed to malrotation.

    • Main Results:

    • 110 abdominal wall defects (congenital diaphragmatic hernias, omphaloceles, gastroschisis) were managed.
    • Eleven patients (11%) experienced symptomatic midgut malrotation during follow-up.
    • Complications included volvulus, gastrocutaneous fistula, and intestinal obstruction; Ladd procedure was the definitive treatment.

    Conclusions:

    • Surgical conditions during initial abdominal wall defect repair may limit malrotation assessment.
    • Obstructive symptoms appearing at any point in life warrant consideration of malrotation.
    • Early recognition and appropriate surgical management (Ladd procedure) are crucial for favorable outcomes.