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Is isomerism a risk factor for intestinal volvulus?
Rachel M Landisch1, Rohit S Loomba2, Jose H Salazar1
1Children's Hospital of Wisconsin/Medical College of Wisconsin, Division of Pediatric Surgery, Milwaukee, WI.
Journal of Pediatric Surgery
|April 2, 2018
Summary
Isomerism (heterotaxy syndrome) increases intestinal malrotation risk but is not an independent risk factor for volvulus. This study clarifies the association, informing clinical practice for affected children.
Area of Science:
- Pediatric Surgery
- Congenital Abnormalities
- Gastrointestinal Motility Disorders
Background:
- Isomerism, also known as heterotaxy syndrome, impacts multiple organ systems.
- Intestinal malrotation is a frequent complication observed in patients with isomerism.
- Current clinical practice varies regarding prophylactic interventions for asymptomatic patients with isomerism and intestinal malrotation due to perceived volvulus risk.
Purpose of the Study:
- To investigate whether isomerism is an independent risk factor for developing volvulus.
- To analyze the association between isomerism, intestinal malrotation, and the incidence of volvulus.
Main Methods:
- A retrospective analysis of the Kid's Inpatient Database (1997-2012).
- Comparison of patient characteristics, focusing on isomerism, intestinal malrotation, and volvulus.
- Logistic regression modeling to identify independent risk factors for volvulus.
Main Results:
- The study analyzed 15,962,403 inpatient admissions, with 7,970 (0.05%) identified as having isomerism.
- Isomerism showed a 52-fold increased odds of intestinal malrotation via univariate analysis.
- Logistic regression confirmed isomerism is not an independent risk factor for volvulus, with only 2.4% of isomerism patients with malrotation experiencing volvulus.
Conclusions:
- Isomerism is significantly associated with an increased risk of intestinal malrotation.
- Despite the association with malrotation, isomerism does not independently predict the occurrence of volvulus.
- Findings suggest a need to re-evaluate routine screening and prophylactic Ladd procedures in asymptomatic patients with isomerism and intestinal malrotation.
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