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Notable Clinical Differences Between Neonatal and Post-Neonatal Intestinal Malrotation: A Multicenter Review in
Chihiro Kedoin1, Mitsuru Muto1, Ayaka Nagano2
1Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
Insights
Neonatal intestinal malrotation often presents with midgut volvulus, while older children show varied symptoms. Neonates are more susceptible to ischemia from even mild torsion, highlighting critical differences in clinical presentation and management.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Medicine
Background:
- Intestinal malrotation presents differently in neonates versus older children.
- Neonatal cases often involve midgut volvulus and bilious vomiting.
- Late-presenting intestinal malrotation has variable initial symptoms.
Purpose of the Study:
- To compare clinical features of intestinal malrotation in neonates and older children.
- To identify key considerations for managing these two distinct patient populations.
- To understand age-related differences in intestinal malrotation presentation and severity.
Main Methods:
- Retrospective chart review from January 1, 2010, to December 31, 2022.
- Data collected from five pediatric surgical centers in Southern Kyushu and Okinawa, Japan.
- Analysis of 80 patients divided into neonatal (Group N) and infant/school-age (Group I) cohorts.
Main Results:
- Midgut volvulus was significantly more frequent in neonates (71.9%) compared to older children (34.8%).
- Older children experienced greater degrees of torsion (median 450°) than neonates (median 360°).
- Neonatal intestines are more susceptible to ischemia, even with milder torsion (180°).
Conclusions:
- Neonates have a higher incidence of midgut volvulus compared to older children.
- Mild torsion can lead to ischemic bowel changes in neonates.
- Clinical management strategies should account for age-specific presentations of intestinal malrotation.
Background:
Most cases of intestinal malrotation appear in neonates with bilious vomiting due to midgut volvulus, whereas in cases that develop beyond infancy, the initial symptoms vary. This study investigated the clinical features of these two populations and identified issues that should be considered in daily practice.
Methods:
A retrospective chart review was conducted from January 1, 2010, to December 31, 2022. Data on patients with intestinal malrotation were collected in an anonymized fashion from five pediatric surgical hub facilities in the Southern Kyushu and Okinawa areas of Japan.
Results:
Of the 80 subjects, 57 (71.3%) were neonates (Group N) and 23 (28.7%) were infants and schoolchildren (Group I). The frequencies of initial symptoms, such as abdominal distention (Group N: 19.3% vs. Group I: 13.0%), bilious vomiting (59.6% vs. 43.5%), and hematochezia (8.8% vs. 21.7%), were not skewed by the age of onset (p = 0.535, 0.087, and 0.141, respectively). Midgut volvulus was significantly more frequent in Group N (71.9% [41/57] vs. 34.8% [8/23]; p = 0.005), while the degree of torsion was greater in group I (median 360° [interquartile range: 180-360°] vs. 450° [360-540°]; p = 0.029). Although the bowel resection rate was equivalent (7.0% [4/57] vs. 4.3% [1/23]; p = 1.000), half of the patients in Group N presented with 180° torsion. The neonatal intestine has been highlighted as being more susceptible to ischemia than that in older children.
Conclusions:
The incidence of midgut volvulus is higher in neonates than in older children. Even relatively mild torsion can cause ischemic bowel changes during the neonatal period.
Level Of Evidence:
LEVEL III.
