Volvulus in preterm neonates: An overlooked diagnosis

Intestinal volvulus is a potentially devastating condition where prompt surgical management can avert significant mortality and morbidity. However, the diagnosis in preterm infants can be challenging. We aimed to compare preoperative presentation, diagnostic pathways, surgical management and postoperative outcomes between preterm and full-term infants with intestinal volvulus.

All neonatal patients with intestinal volvulus confirmed on laparotomy in the two year period October 2023 to September 2025 were identified using the electronic patient record. Patients were categorized into Group A (preterm, <37 weeks) and Group B (full-term, ≥37 weeks). Data including demographics, age at presentation, reason for referral, time to surgery, and postoperative course were extracted from the electronic patient record and compared.

Eighteen infants were included (9 per group). Premature infants were significantly less likely to present with bilious vomiting (p = 0.015) and more likely to present with abdominal distension (p = 0.02) and generalized deterioration. Initial clinical impression favoured necrotizing enterocolitis (NEC) in preterms. Preterm infants had a longer median time from referral to surgery (12 vs. 2.5 h) and higher intestinal resection rates (66.6% vs. 44.4%), though these did not reach statistical significance. Preterm infants experienced significantly more postoperative complications (p < 0.01), longer times to full feeds (p = 0.010), and longer hospital stays (p = 0.007).

Volvulus in preterm infants is frequently misidentified as NEC due to atypical presentation. This diagnostic challenge leads to delays in surgical intervention and is associated with significantly higher morbidity and mortality compared to term infants.