Malrotation presenting beyond infancy: a clinical study
Background: Intestinal malrotation is a congenital anomaly that results from abnormal or incomplete rotation and fixation of midgut during embryonic development. This study was done at Niloufer Hospital and Institute for Women and Child Health, Hyderabad with an aim of evaluating the clinical presentation, diagnosis, management and outcome of malrotation presenting beyond 1 year of life
Methods: Overall 50 cases of malrotation presented to the department of pediatric surgery over a period of 2 year (April 2015 to April 2017). 12 patients of these 50 (12/50) whose age was above 1 year i.e. who were beyond infancy were studied in this study
Results: Out of the 12 patients, 6 were female and 6 were male. Age of patients ranged from 15 months to 13 years. Younger patients below 2 years commonly presented with typical symptoms of bilious vomiting and patients above 2 years of age presented with more varied and vague symptoms. 1/12 of patients presented with a poor general condition and succumbed during the course of treatment
Conclusion: Small intestinal obstruction due to malrotation is relatively common in neonatal period. Malrotation beyond infancy is an uncommon diagnosis. Malrotation in grown up children usually is not suspected due to varied symptoms. High index of suspicion is needed as early intervention and treatment in the form of Ladds procedure can prevent any catastrophic events like volvulus and bowel ischemia.
Filston HC, Kriks DR. Malrotation: the ubiquitous anamoly. J Ped Surg. 1981;16(4):614-20.
Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17(3):326-31.
Andrassy RJ, Mahour GH. Malrotation of the midgut in infants and children. Arch surg. 1891;16:158-60.
Nagdeva NG, Qureshi AM, Bhingare PD, Shinde SK. Malrotation beyond infancy. J Ped Surg. 2012;47:2026-32.
Penco JM, Murrillo JC, Hernandez A, et al. Anamolis of intestinal rotation and fixation, consequences of late diagnosis beyond 2yrs of age, Pediatr Surg Int. 2007;23:723-30
Durkin ET, Lund DP, Shaabam AF. Age related differences in diagnosis and morbidity of intestinal malrotation. J Am Coll Surg. 2008;206:658-63.
Spigland N, Brandt ML, Yazbeck S. Malrotation presenting beyond the neonatal period. J Pediatr Surg. 1990;25:1139-42.
Brandt ML, Pokarny WI, Mc Gill CW. Late presentations of midgut malrotation in children. Am J Surg. 1985;150:767-71.
Kullendorf CM, Mikaelsson C, Ivaneev K. Malrotation in children with symptoms of gastrointestinal allergy and psychosomatic abdominal pain. Acta pediatr Scand. 1982;74:469-72.
Sasaki T, Soh H, Kimura T. Recurrence acute pancreatitis caused by malrotation of the intestine and effective treatment with laparoscopic ladds procedure. Paed Surg Int. 2005;21:994-6.
Kirby CP, Freeman JK, Ford WDA. Malrotation with recurrent volvulus presenting with cholestasis. Paed surg Int. 2000;16:130-1.
Firor HV, Steiger E. Morbidity of rotational abnormalities of gut beyond infancy. Clece Clin Quarterly. 1983;50:303-9.
Howell CG, Vozza F, Shaw S. Malrotation, malnutrition and ischemic bowel disease. J Pediatr Surg. 1982;17:469-72.
Fukaya T, Brown BP, Lu CC. Midgut volvulus as acomplication of intestinal malrotation in adults. Dig Dis Sci. 1993;38:438-44.
Rowson JT, Sullivan SN, Girvan DP. Midgut volvulus in the adult, a complication of intestinal malrotation. J Clin Gastroenterol. 1987;9:212-6.