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Malrotation beyond infancy
Nilesh G Nagdeve1, Abdul M Qureshi, Pravin D Bhingare
1Department of Surgery, Pediatric Surgery Unit, Government Medical College, Nagpur 44003, India. nileshngn74@yahoomail.co.in
Insights
Intestinal malrotation can present with varied symptoms in patients over one year old. Early diagnosis and surgical correction, like the Ladd procedure, are crucial for preventing complications such as midgut volvulus.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Intestinal malrotation is a congenital anomaly that can manifest with diverse clinical presentations, often challenging diagnosis in patients over one year of age.
- Delayed diagnosis in older children and adults can lead to severe complications, including midgut volvulus and intestinal obstruction.
Purpose of the Study:
- To investigate the varied clinical presentations of intestinal malrotation in patients older than one year.
- To evaluate the diagnostic methods and management strategies for intestinal malrotation in this age group.
Main Methods:
- Retrospective analysis of medical records for patients over one year old diagnosed with intestinal malrotation over a six-year period.
- Data collected included age, sex, symptoms, diagnostic imaging, surgical procedures, complications, and follow-up outcomes.
Main Results:
- The study included 35 children and 3 adults, with older patients more frequently presenting with atypical symptoms, including misdiagnosis as abdominal tuberculosis or pancreatitis.
- Upper gastrointestinal contrast studies were diagnostic in all pediatric cases; ultrasound and Doppler identified vascular anomalies in one-third of patients.
- The Ladd procedure was performed on all patients, with midgut volvulus present in approximately 25%. Forty percent of atypical presentations had persistent symptoms postoperatively.
Conclusions:
- Intestinal malrotation should be suspected in patients of all ages presenting with acute or chronic abdominal symptoms.
- Upper gastrointestinal contrast studies are essential for diagnosis, and surgical correction is mandatory to prevent volvulus and obstruction, regardless of age.
Objective:
The aim of this work was to study the various presentations of malrotation and management in patients older than 1 year.
Materials And Methods:
Medical records of patients operated on over the last 6 years who were older than 1 year with a diagnosis of intestinal malrotation were evaluated retrospectively. Data about age at presentation, sex, presenting symptoms, time to diagnosis, radiographic imaging performed, surgical intervention, complications, and postoperative follow-up were collected and evaluated.
Results:
The study population included 35 children and 3 adults. About three-fourths of pediatric patients were younger than 5 years, and about half of these presented in the second year of life. All patients who presented in the second year of life had a classical presentation of malrotation. Older patients presented more commonly with atypical symptoms. Of these, 5 older children were previously treated for suspected diagnosis of abdominal tuberculosis. Two patients were referred for acute pancreatitis and 1 for severe gastroesophageal reflux disease. Three adults presented with acute small intestinal obstruction and were diagnosed to have malrotation intraoperatively. Upper gastrointestinal contrast study was diagnostic of malrotation in all pediatric patients. Ultrasound and color Doppler study of the abdomen revealed abnormal relationship of the superior mesenteric artery and vein in about one-third of the patients. All patients underwent a standard Ladd procedure. Midgut volvulus was present in about one-fourth of patients. Forty percent of patients with atypical presentation had persistence of preoperative symptoms postoperatively. Two adults developed complications postoperatively. There was no mortality in the present study.
Conclusion:
Malrotation should be suspected in all patients with varied acute or chronic abdominal symptoms, and the upper gastrointestinal contrast study should be conducted. If the existence of typical malrotation is confirmed, surgical correction is mandatory to avoid volvulus and intestinal obstruction independently of the patient's age.
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