Clinical Presentation of Midgut Malrotation in Children Beyond the Neonatal Period.

Abstract

Midgut malrotation usually presents acutely in the neonatal period. Presentation outside the neonatal period is uncommon and may at tines be atypical. Medical records of 17 children over one month of age presenting with midgut malrotation were reviewed. Contrary to the classical acute presentation in the neonates, older children were found to present with widely varying pattern of clinical features that were often non-specific and less dramatic, leading to a significant delay in the diagnosis. These included failure to thrive, chronic non-specific abdominal complaints and malabsorption syndrome; it was observed that while the mortality associated with acute volvulus is well recognised, the morbidity associated with chronic / intermittent volvulus in infants and older children is not adequately appreciated. Because of the unpredictability and high mortality and morbidity associated with acute and chronic volvulus, prompt diagnosis and surgical correction in the form of Ladd’s procedure is recommended in every patient with midgut malrotation.