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Published on: December 1, 2012
Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective
Xiaofeng Yang1, Wei Wang2, Kun Wang3
1Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, China.
Insights
Delayed diagnosis of intestinal malrotation in children can be fatal. This study highlights the importance of recognizing non-bilious vomiting and using ultrasound (US) for early detection and treatment of pediatric intestinal malrotation.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Imaging
- Congenital Abnormalities
Background:
- Intestinal malrotation is a rare congenital anomaly with potentially severe consequences if diagnosis is delayed.
- Early identification and appropriate management are critical for improving outcomes in affected children.
Purpose of the Study:
- To investigate the diagnostic methods and treatment strategies for intestinal malrotation in pediatric patients.
- To analyze clinical presentations, imaging findings, surgical outcomes, and postoperative complications.
Main Methods:
- Retrospective analysis of clinical data, imaging results, operative findings, and postoperative outcomes for 75 children diagnosed with intestinal malrotation.
- Comparison of presentation and outcomes between neonatal and non-neonatal groups.
Main Results:
- Sixty-seven patients were diagnosed before age 1 year; 88% had midgut volvulus.
- Bilious vomiting and jaundice were significantly more common in neonates (89.29%) than non-neonates (37.5%).
- Ultrasound (US) showed high diagnostic accuracy (97.30-100%); open Ladd's procedure was common in neonates.
Conclusions:
- Non-bilious vomiting can be an initial symptom, necessitating vigilance in neonates and non-neonates.
- Ultrasound (US) is recommended as a first-line imaging technique due to its accuracy and speed.
- Open surgery remains a viable option for neonatal intestinal malrotation treatment.
Background:
Intestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of malrotation in children.
Methods:
Clinical data, imaging, operative findings, and early postoperative outcomes of 75 children with malrotation were retrospectively analyzed.
Results:
The mean age was 6.18 ± 4.93 days and 51.26 ± 70.13 months in the neonatal group (56 patients) and non-neonatal group (19 patients), respectively. Sixty-seven patients were under the age of 1 year at the time of diagnosis. The occurrence of bilious vomiting and jaundice was significantly higher in the neonatal group (89.29%) than that in the non-neonatal group (37.5%), p < 0.05 and p < 0.01, respectively. The incidence of abnormal ultrasound (US) findings was 97.30% and 100%, respectively, and the sensitivities of the upper gastrointestinal series were 84.21% and 87.5%, respectively. Sixty-six (88%) patients had midgut volvulus, including in utero volvulus (two patients) and irreversible intestinal ischemia (four patients). Most neonates (89.29%) underwent open Ladd's procedure with a shorter operative time (p < 0.01). Reoperation was performed for postoperative complications (four patients) or missed comorbidities (two patients).
Conclusions:
Non-bilious vomiting was the initial symptom in >10% of neonates and nearly 40% of non-neonates. This highlights the importance for emergency physicians and surgeons to be cautious about ruling out malrotation in patients with non-bilious vomiting. Utilizing US can obviate the need for contrast examinations owing to its higher diagnostic accuracy and rapid diagnosis and can be recommended as a first-line imaging technique. Additionally, open surgery is still an option for neonatal patients.
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