Malrotation beyond infancy

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.