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The identification and treatment of intestinal malrotation in older children
Charlene Dekonenko1, Joseph A Sujka1, Katrina Weaver1
1Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Insights
Intestinal malrotation can occur in patients over one year old, often presenting with vomiting or abdominal pain. Upper GI (UGI) series are effective for diagnosing this condition, leading to symptom alleviation after surgical intervention.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intestinal malrotation is typically diagnosed in infants.
- The incidence and presentation of malrotation in older children and adults are less understood.
- Atypical or asymptomatic presentations can delay diagnosis.
Purpose of the Study:
- To determine the incidence of intestinal malrotation in patients over one year of age.
- To characterize the clinical presentation, diagnostic imaging, and intra-operative findings in this age group.
- To evaluate the effectiveness of surgical intervention for alleviating symptoms.
Main Methods:
- Retrospective review of patients over one year old diagnosed with malrotation between 2000 and 2015.
- Analysis of demographics, clinical presentation, imaging studies, and surgical outcomes.
- Exclusion of patients with predisposing conditions for malrotation.
Main Results:
- 77 out of 246 (31%) patients diagnosed with malrotation were over one year old.
- Vomiting (68%) and abdominal pain (57%) were the most common symptoms.
- Upper GI (UGI) series diagnosed malrotation in 88% of cases, confirmed surgically in 73 of 75 patients.
- Intra-operative findings included malrotated (60%) or non-rotated (33%) intestinal orientation, with obstruction in 22% and volvulus in 12%.
- 58% of patients experienced symptom alleviation post-surgery.
Conclusions:
- Intestinal malrotation should be considered in the differential diagnosis for patients over one year old, regardless of age.
- Variable clinical presentations necessitate a high index of suspicion.
- UGI series are crucial for prompt diagnosis and timely surgical intervention, leading to symptom resolution.
Purpose:
Intestinal malrotation is often diagnosed in infancy. The true incidence of malrotation outside of this age is unknown. These patients can present atypically or be asymptomatic and diagnosed incidentally. We evaluate the incidence, clinical presentation, ideal imaging, and intra-operative findings of patients with malrotation over 1 year of age.
Methods:
Retrospective review was conducted in patients older than 1 year, treated for malrotation at a single pediatric tertiary care center from 2000 to 2015. Data analyzed included demographics, presentation, imaging, intraoperative findings, and follow-up. Patients predisposed to malrotation were excluded.
Results:
246 patients were diagnosed with malrotation, of which 77 patients were older than 1 year of age. The most common presenting symptoms were vomiting (68%) and abdominal pain (57%). The most common method of diagnosis was UGI (61%). In 88%, the UGI revealed malrotation. 73 of 75 were confirmed to have malrotation at surgery. Intra-operatively, 60% were found to have a malrotated intestinal orientation and 33% with a non-rotated orientation. Obstruction was present in 22% with 12% having volvulus. Of those with follow-up, 58% reported alleviation of symptoms.
Conclusion:
Despite age malrotation should be on the differential given a variable clinical presentation. UGI should be conducted to allow for prompt diagnosis and surgical intervention.
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