Background Early diagnosis and management of intestinal malrotation can potentially prevent the devastating complications associated with midgut volvulus. Atypical presentation of intestinal malrotation in older children frequently leads to a significant delay in diagnosis.
Methods A 6-year-old boy presented with a five year history of hiccups, then vomiting after laughing. Sadly, he had resorted to avoiding laughter. Barium studies demonstrated intestinal malrotation, therefore a Ladd’s procedure was performed and he made a good recovery. The case prompted a literature search for aetiology, diagnosis and management of malrotation in children outside of the neonatal period.
Results We present a review of this literature, including findings that diagnosis of intestinal malrotation in the older child is frequently delayed. One study demonstrated a mean delay to diagnosis of 1.7 years. Vague abdominal symptoms including chronic abdominal pain, intermittent non-bilious vomiting, diarrhoea and failure to thrive have been associated with malrotation, but hiccups and laughter have not previously been described. Recent review of diagnostic imaging recommended ultrasound as the investigation of choice, and may advocate its use in the work up of children presenting with non-specific abdominal symptoms. Although debated in the literature, a Ladd’s procedure is recommended for all children, even if asymptomatic.
Conclusion Children with intestinal malrotation present us with a diagnostic challenge, but a low threshold of suspicion in patients presenting with vague abdominal symptoms, including intractable hiccups or vomiting, may ensure these children receive the timely surgical intervention.