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Segmental volvulus in the neonate: A particular clinical entity
Naziha Khen-Dunlop1, Sylvie Beaudoin2, Blandine Marion3
1AP-HP, Hôpital Necker-Enfants malades, Service de Chirurgie Pédiatrique Viscérale, Paris, France; Université Paris Descartes, Paris, France; EA 7328 FETUS, Hôpital Necker-Enfants malades, Paris, France.
Journal of Pediatric Surgery
|April 27, 2017
Summary
Neonatal segmental volvulus, distinct from complete midgut volvulus, often presents with prenatal ultrasound anomalies and leads to significant postnatal morbidity despite limited intestinal loss.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Motility Disorders
Background:
- Complete intestinal volvulus is typically linked to congenital intestinal malrotation.
- Segmental volvulus is a distinct neonatal condition, often occurring perinatally.
- Current classifications often group these conditions, necessitating differentiation.
Purpose of the Study:
- To delineate the specific characteristics of neonatal segmental volvulus.
- To compare neonatal segmental volvulus with complete midgut volvulus.
- To analyze diagnostic and management strategies for neonatal segmental volvulus.
Main Methods:
- Retrospective analysis of 17 neonates operated for segmental volvulus over 10 years.
- Comparison with 19 neonates operated for complete midgut volvulus during the same period.
- Data collection included prenatal diagnosis, operative findings, and treatment outcomes.
Main Results:
- Prenatal ultrasound anomalies were detected in 94% of segmental volvulus cases, significantly higher than in complete volvulus.
- Intestinal malposition was observed in 23% of segmental volvulus versus 100% of complete volvulus.
- Intestinal resection was required in 88% of segmental volvulus cases, with parenteral nutrition needed for a median of 50 days.
Conclusions:
- Neonatal segmental volvulus is predominantly diagnosed prenatally, indicated by fetal ultrasound anomalies.
- This condition, despite potentially limited intestinal resection, is associated with substantial postnatal morbidity.
- Distinguishing segmental volvulus from complete midgut volvulus is crucial for appropriate management and prognosis.
