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Delayed Presentation of Malrotation after Infancy: A Systematic Review Based on Clinical Presentations, Associated

Charu Sharma1, Nitinkumar Bhajandas Borkar1, C Ashwin1

  • 1Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India.

Journal of Indian Association of Pediatric Surgeons
|October 31, 2024
PubMed

Insights

This review examines intestinal malrotation diagnosed after infancy, detailing its varied presentations and management. It highlights acute symptoms like abdominal pain and bilious vomiting, and chronic issues such as intermittent pain, vomiting, and diarrhea.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Developmental Biology

Background:

  • Intestinal malrotation and midgut volvulus predominantly affect neonates.
  • Diagnosis in infancy is typically based on classic presentations.
  • However, malrotation can be diagnosed in older children, with limited data on incidence, presentation, and management.

Purpose of the Study:

  • To systematically review and synthesize findings on intestinal malrotation diagnosed after infancy.
  • To consolidate information on its incidence, clinical presentation, diagnostic modalities, and management strategies.

Main Methods:

  • Systematic review conducted following PRISMA guidelines.
  • Comprehensive literature search across PubMed/MEDLINE, SCOPUS, Google Scholar, and Web of Science.
  • Analysis of studies focusing on clinical presentation and outcomes of malrotation diagnosed beyond infancy.

Main Results:

  • Clinical presentations vary from acute (common under 2 years) to chronic (increasing with age).
  • Acute symptoms include sudden abdominal pain and bilious vomiting.
  • Chronic symptoms involve intermittent vague abdominal pain, vomiting, and diarrhea.
  • Diagnostic tools range from UGI contrast series to USG with color Doppler and CECT scans.
  • Surgical management, including open and laparoscopic Ladd's procedures, is favored.

Conclusions:

  • Intestinal malrotation beyond infancy presents with diverse acute and chronic symptoms.
  • A range of diagnostic imaging modalities are employed.
  • Surgical intervention, particularly the Ladd's procedure, remains the standard of care.
Abstract

Keywords:
After infancyPresentation of malrotation beyond infancy is infact more than that reported in literature. Timely and appropriate diagnosis of malrotation is essential to avoid gangrene and subsequent gut loss and morbidity.delayedmalrotation of gutpresentation

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