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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.
Background:
Midgut malrotation has a low incidence (0.5-1% at necropsies) and it is a rare symptomatic condition. Nevertheless it is often associated to clinical situations with a high morbility and mortality and it could complicate them. Our aim is to study the patients treated for abdominal wall defects and who have suffered complications due to non-treated malrotation at first surgery.
Methods:
We retrospectively studied the charts of patients diagnosed of abdominal wall defects in our hospital from 1993 to 2002. We reviewed the initial treatment, the associated morbility and any new surgical treatment needed.
Results:
During this 10-year period, 110 abdominal wall defects were managed: 56 congenital diaphragmatic hernias, 30 onphaloceles and 14 gastroschisis; overall 79 of these 100 patients survived and were included in this study. Eleven patients had symptoms due to bowel malrotation during the follow-up period. In 1 case the clinical picture had an acute onset as a volvulus that required extensive gut resection; another patient presented as a persistent gastrocutaneous fistula after removal of a gastrostomy tube; in the remaining 9, symptoms were always of classical intestinal obstruction. The malrotation was never treated during the initial surgical procedure for abdominal wall defect; later on, Ladd procedure was always the definitive treatment.
Conclusions:
Due to local conditions during first abdominal wall surgery that limit the evaluation of the malrotation, we must think about it when we find obstructive symptoms any time during life.
Insights
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.
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.
- 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.
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