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Malrotation presenting beyond the neonatal period.

N Spigland1, M L Brandt, S Yazbeck

  • 1Ste-Justine Hospital, Montreal, Quebec, Canada.

Journal of Pediatric Surgery
|November 1, 1990
PubMed
Summary

Diagnosis of intestinal malrotation is often delayed in older children and adults, leading to complications. Increased awareness of varied symptoms in non-neonatal patients can improve timely surgical intervention and outcomes.

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Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Surgical Diagnostics

Background:

  • Intestinal malrotation is commonly diagnosed in neonates, but diagnosis is frequently delayed in older patients.
  • Delayed diagnosis in older individuals can lead to significant morbidity and unusual presentations.

Purpose of the Study:

  • To analyze the diagnostic delay and clinical features of intestinal malrotation in patients diagnosed beyond the neonatal period.
  • To highlight the importance of recognizing varied presentations for timely surgical intervention.

Main Methods:

  • Retrospective review of 82 patients treated for intestinal malrotation.
  • Analysis of patient demographics, age at diagnosis and surgery, presenting symptoms, and surgical outcomes.
  • Comparison of clinical features and outcomes between neonatal and older patient groups.

Main Results:

  • Of 82 patients, 30 had incidental findings, 45 were symptomatic, and 7 were diagnosed during surgery for duodenal obstruction.
  • Symptomatic older patients (20) had a mean diagnostic delay of 1.7 years, with varied symptoms including obstruction, pain, and malabsorption.
  • Unusual malrotation forms and complications like venous thrombosis and gangrene were more frequent in older patients; Ladd's procedure was universally applied with adhesive obstruction as the main complication.

Conclusions:

  • Awareness of diverse clinical presentations in older patients is crucial to reduce diagnostic delays.
  • Laparotomy is recommended for all patients with intestinal malrotation, including asymptomatic cases.
  • Early diagnosis and surgical treatment of intestinal malrotation, regardless of age, are essential to prevent severe complications.

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