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Neonatal Intestinal Segmental Volvulus: What Are the Differences with Midgut Volvulus?
Maria Casalino1, Maria Enrica Miscia2, Giuseppe Lauriti3
1Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
Summary
Segmental volvulus (SV) in neonates presents differently than midgut volvulus (MV), often showing abnormal fetal ultrasound findings and requiring more bowel resection. Differentiating SV from MV is crucial for appropriate neonatal care.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Surgical pathology
Background:
- Intestinal volvulus in neonates is a critical surgical emergency.
- It is primarily caused by midgut volvulus (MV) associated with intestinal malrotation or, less frequently, by segmental volvulus (SV) without malrotation.
Purpose of the Study:
- To determine if midgut volvulus (MV) and segmental volvulus (SV) in neonates can be distinguished based on clinical presentation, intraoperative findings, and postoperative outcomes.
Main Methods:
- A systematic literature search identified studies comparing MV and SV in neonates.
- PRISMA guidelines were followed, and a meta-analysis was conducted using RevMan 5.3.
Main Results:
- Segmental volvulus (SV) was linked to abnormal fetal ultrasound findings (65% vs. 11.6%) and abdominal distension (77% vs. 32%).
- Intraoperatively, SV showed a higher incidence of intestinal atresia (19% vs. 2%) and necessitated bowel resection (91% vs. 13%).
- No significant differences were observed in postoperative complications, short bowel syndrome, or mortality between MV and SV groups.
Conclusions:
- Segmental volvulus (SV) is a distinct clinical entity in neonates with unique features differentiating it from midgut volvulus (MV).
- SV should be considered in the differential diagnosis of neonatal bilious vomiting, particularly when MV is ruled out and abnormal fetal ultrasound or abdominal distension is present.
