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Updated: Mar 18, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Intestinal malrotation needs immediate consideration and investigation
Semire Serin Ezer1, Pelin Oguzkurt1, Abdulkerim Temiz1
1Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey.
Insights
Intestinal malrotation, a condition that can occur at any age, often presents with subtle or unusual symptoms, delaying diagnosis. Early detection and surgical intervention are crucial to prevent severe complications like midgut volvulus.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Diagnostics
Background:
- Intestinal malrotation is a congenital anomaly where the intestines fail to rotate properly during fetal development.
- This condition can lead to serious complications, including midgut volvulus, which compromises blood supply to the intestines.
Purpose of the Study:
- To evaluate the clinical presentation, diagnostic methods, and incidence of volvulus in patients with intestinal malrotation.
- To identify unusual clinical clues that may aid in the early diagnosis of this condition.
Main Methods:
- A retrospective descriptive review of patients diagnosed with intestinal malrotation between 2002 and 2014.
- Patients were categorized into two groups: infants (≤1 year) and children (>1 year).
- Data collected included demographics, clinical history, symptoms, physical examination, diagnostic work-up, operative findings, and early outcomes.
Main Results:
- Bilious vomiting was the primary symptom in both infant and older child groups.
- Unusual symptoms in infants included respiratory insufficiency, dehydration, afebrile convulsions, and lethargy.
- In older children, recurrent abdominal pain and feeding intolerance requiring frequent hospitalizations were noted. Midgut volvulus was present in 15 patients.
Conclusions:
- Intestinal malrotation, with or without midgut volvulus, is a significant condition across all age groups.
- Diagnosis can be challenging due to non-specific or unusual presentations, potentially leading to delayed treatment and catastrophic outcomes.
- Prompt diagnosis and surgical management, such as Ladd's procedure, are essential, especially considering the high risk of complications in children over one year of age.
Background:
The aim of this study was to evaluate clinical presentation, diagnostic studies, and volvulus rate and to describe the unusual clinical clues of intestinal malrotation.
Methods:
A retrospective descriptive review was carried out of all patients diagnosed with intestinal malrotation between 2002 and 2014. Patients were divided into two groups: infants (≤1 year, n = 16; group 1); and children (>1 year, n = 12; group 2). Patient demographics, clinical history, symptoms, physical examination, diagnostic work-up, operative findings and early outcome were evaluated.
Results:
Bilious vomiting was the cardinal complaint in both groups. Unusual symptoms such as respiratory insufficiency, dehydration, afebrile convulsion, and lethargy were prominent symptoms in six patients in group 1, whereas history of frequent hospitalization due to recurrent abdominal pain and feeding intolerance were prominent in six patients in group 2. Midgut volvulus was identified in 15 patients, four of whom were in group 2. Standard Ladd's procedure was done in addition to correction of volvulus.
Conclusion:
Malrotation with or without midgut volvulus is not a rare condition and should be kept in mind for any age group. Specific signs of diagnosis are not easily identified. In the case of unusual clinical presentation, diagnosis may be delayed and can result in catastrophic consequences if intestinal perfusion occurs. Although midgut volvulus is seen most frequently in infants, risk and complication rate are high beyond 1 year of age as well, and can manifest as failure to thrive, food intolerance, and abdominal pain needing recurrent hospitalization. Diagnostic suspicion and interdisciplinary coordination are essential for timely diagnosis and surgical treatment.
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