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Malrotation and midgut volvulus presenting as malabsorption
A Jackson1, R Bisset, A P Dickson
1Department of Diagnostic Radiology, Booth Hall Children's Hospital, Blackley.
Insights
Midgut volvulus due to intestinal malrotation typically causes early-life intestinal obstruction. This case highlights the need to consider this rare condition in older children with malabsorption and failure to thrive.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Intestinal malrotation is a congenital anomaly where the intestines fail to rotate properly during fetal development.
- Midgut volvulus, a surgical emergency, occurs when the malrotated intestine twists around the mesenteric axis, potentially leading to ischemia.
- Classic presentation involves complete or intermittent high intestinal obstruction in infancy.
Observation:
- A 16-month-old boy presented with symptoms of malabsorption and failure to thrive.
- This clinical presentation is atypical for the classic early-onset intestinal obstruction associated with midgut volvulus and malrotation.
- The patient's delayed presentation underscores the variable clinical spectrum of this condition.
Findings:
- The case highlights a delayed diagnosis of midgut volvulus associated with intestinal malrotation in a toddler.
- Malabsorption and failure to thrive were the presenting symptoms, deviating from the typical neonatal presentation.
- Diagnostic considerations for intestinal obstruction in older children should include rare congenital anomalies.
Implications:
- This case emphasizes the importance of maintaining a high index of suspicion for midgut volvulus in children with unexplained malabsorption and failure to thrive, regardless of age.
- Early recognition and surgical intervention are crucial to prevent intestinal compromise and long-term sequelae.
- Broadening the differential diagnosis for pediatric intestinal issues can improve patient outcomes.
Abstract:
Volvulus of the midgut associated with intestinal malrotation classically presents in early life with complete, or intermittent, high intestinal obstruction. We describe the case of a boy presenting at 16 months of age with a history of malabsorption and failure to thrive. The importance of considering this rare diagnosis in such cases is discussed.