Malrotation of the intestines in children: The effect of age on presentation and therapy*

https://doi.org/10.1016/S0022-3468(89)80535-4Get rights and content

Because of the devastating consequences of midgut volvulus as a result of malrotation, we reviewed the charts of 70 consecutive children to define the spectrum of presentation. Although 27 patients (39%) had presenting symptoms within the first ten days of life, 35 (50%) were older than 2 months of age. In general, the older children had a longer course of vague, antecedent symptoms such as intermittent, nonbilious vomiting and chronic abdominal pain. Associated congenital anomalies were common, with 32 patients (46%) presenting with 56 anomalies, the most prevalent of which were intestinal atresia, imperforate anus, duodenal web, and cardiac and orthopedic anomalies. Upper gastrointestinal (GI) series revealed the diagnosis in 29 cases (41%), as did contrast enema in 24 (34%). It is important to note that volvulus, intestinal gangrene, and mortality occurred regardless of age or chronicity of symptoms. Fifteen patients (21%) were discovered serendipitously while being evaluated and treated for seemingly unrelated conditions. No morbidity of mortality occurred in those patients who underwent subsequent semielective Ladd's procedure. The majority of morbidity and all seven mortalities occurred in patients with volvulus and intestinal necrosis. This study emphasizes the need for consideration of Ladd's procedure for children of all ages. In addition, due to the broad range of initial symptoms, a high index of suspicion is required in evaluating children with possible malrotation. Because it remains impossible to predict which patients will have catastrophic complicatiosn (based on age or type of presentation), we urge that even incidentally discovered patients with intestinal malrotation undergo Ladd's procedure.

References (17)

There are more references available in the full text version of this article.

Cited by (161)

  • Pediatric gastroesophageal reflux disease in primary care: Evaluation and care update

    2020, Current Problems in Pediatric and Adolescent Health Care
  • Abnormal Rotation and Fixation of the Intestine

    2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
View all citing articles on Scopus
*

Presented at the 37th Annual Meeting of the Surgical Section of the American Academy of Pediatrics, San Francisco, California, October 15–17, 1988.

1

From the Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston.

View full text