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Intestinal malrotation presenting outside the neonatal period
Insights
Intestinal malrotation in children presents with varied symptoms like vomiting and poor growth. Prompt diagnosis and surgical treatment, such as Ladd's procedure, lead to favorable outcomes in most cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Intestinal malrotation is a congenital anomaly affecting the gastrointestinal tract.
- Early diagnosis and intervention are crucial for preventing complications.
Purpose of the Study:
- To analyze the clinical presentation, diagnosis, and surgical outcomes of intestinal malrotation in pediatric patients.
- To highlight the importance of considering malrotation in the differential diagnosis of pediatric abdominal symptoms.
Main Methods:
- Retrospective review of 37 pediatric patients treated for intestinal malrotation over five years.
- Diagnosis confirmed using gastrointestinal contrast studies.
- Surgical treatment involved a standard Ladd's procedure.
Main Results:
- Common presenting features included intermittent vomiting, failure to thrive, and recurrent abdominal pain.
- Midgut volvulus occurred in only 14% of patients, contrasting with higher rates in neonates.
- Two deaths were recorded; 94% of survivors showed favorable responses to surgery.
- Nearly half of the patients presented with poor nutritional status.
Conclusions:
- Intestinal malrotation requires prompt diagnosis and surgical management.
- Ladd's procedure is an effective treatment for pediatric intestinal malrotation.
- The condition should be considered in the differential diagnosis for a broad spectrum of pediatric symptoms.
Abstract:
We report 37 patients ranging in age from 1 month to 14 years treated for intestinal malrotation during a five year period. The main presenting features consisted of intermittent attacks of vomiting (15 patients), failure to thrive (seven), and recurrent colicky abdominal pain (seven). The diagnosis was confirmed by gastrointestinal contrast studies in all but three patients. A standard Ladd's procedure comprised the definitive surgical treatment. We emphasise the poor nutritional state at the time of operation (49% of the cases were on or below the third centile). In contrast with neonatal presentation, volvulus of the midgut occurred in only five patients (14%) compared with 68% in neonates with malrotation. There were two deaths in the series. Ninety four per cent of the remaining patients responded favourably to the operative procedure. Malrotation should be considered in the differential diagnosis of a wide variety of symptoms and should be treated promptly once the diagnosis has been confirmed.