Malrotation of the intestine in childhood
Keywords:
Malrotation, Non-rotationAbstract
Sixty patients were operated on at Children's Hospital between 1985-1 995 for abnormalities of intestinal rotation with or without volvulus. Thirty five were male and twenty five were female. All had clinical manifestations of high gut obstruction. The most common symptom of malrotation in neonates and infants was bilious vomiting while the older children had a long course of vague abdominal pain with or without bilious vomiting. Forty one patients (68:3 per cent) developed clinical presentations in the first month of life. Upper gastrointestinal series were performed for diagnosis in 50 patients, with no false-negative studies. Ten in 50 cases (20 per cent) were found to have the corkscrew sign of volvulus. Two patients required a barium enema in order to confirm the diagnosis because of suspicion of a volvulus with gangrenous bowels. An abnormal location of the cecum was found in both of them.
Sixty patients underwent a Ladd's procedure, including appendectomy. Twenty four (40 per cent) had malrotation alone while 36 (60 per cent) had malrotation with midgut volvulus. Eight of the 36 patients had bowel gangrene. A gastric perforation was noted in two patients. Eight patients were found to have both malrotation and intrinsic duodenal obstruction.
Eight patients died due to bowel gangrene, sepsis, pneumonia and serious congenital anomalies. The total mortality rate was 13:3 per cent. The mortality rate in the patients with malrotation alone was 8.3 per cent while the mortality rate in the patients with malrotation and volvulus increased to 16.7 per cent. This study emphasizes the need for consideration of Ladd's procedure for children of all ages when a malrotation of the intestine is discovered, If the operation is delayed, midgut volvulus may occur at any time.
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