No safe time window in malrotation and volvulus: A consecutive cohort study.

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Emergency Medicine

Background:

• Malrotation with midgut volvulus classically presents with bilious vomiting, often in neonates.
• A
• watch and wait
• strategy is sometimes employed but can be fatal if volvulus is present.
• The literature lacks clarity on safe observation windows for children with suspected malrotation and volvulus.

Purpose of the Study:

• To investigate the correlation between the time to identify and manage midgut volvulus and patient morbidity/mortality.
• To identify patterns in the transition of care for pediatric patients with malrotation and volvulus.

Main Methods:

• A multicenter, retrospective review of pediatric cases of malrotation with or without volvulus from 2000 to 2012.
• Data included age, symptom onset to presentation/management timing, radiological findings, and surgical outcomes (LOS, TPN, re-operations, death).

Main Results:

• Of 96 identified cases, 73 were included; 66% were neonates, and 71% presented with bilious vomiting.
• Overall mortality was 5.56%. Time to presentation or management did not significantly correlate with morbidity or mortality.
• Post-operative total parenteral nutrition (TPN) was associated with significantly higher mortality (P = 0.02).

Conclusions:

• Malrotation and volvulus are time-critical diagnoses requiring urgent evaluation and treatment.
• There is no safe
• watch and wait
• period; contrast studies should be performed emergently to exclude malrotation/volvulus.
• Even brief symptom duration can result in significant morbidity and mortality.