Midgut Malrotation in Children: Our Experience in 33 Cases.

Abstract

Midgut malrotation (MM) typically presents with bilious vomiting, with or without abdominal distension. However, there is a wide spectrum of associated clinical features that may, on occasion, lead to a delayed or erroneous diagnosis. In this retrospective study, medical records of 33 children with MM were reviewed. Seventeen patients (52%) presented in the neonatal period, seven (21%) in the infancy and nine (27%) after the first year of life. Seventy percent of patients presented with bilious vomiting. Although more common in the neonates, acute volvulus occurred in all age groups. Abdominal distension associated with irritability, bilious vomiting and bleeding per rectum were the most consistent indicators of intestinal strangulation. In the patients presenting beyond the neonatal period, the features of chronic/ intermittent volvulus were more evident. These included failure to thrive, chronic non-specific abdominal complaints and malabsorption syndrome. Upper gastrointestinal contrast studies and ultrasound scan were the most commonly used investigations and were almost equally reliable. The mortality associated with acute volvulus is well recognised, but the morbidity associated with chronic/ intermittent volvulus in infants and older children is not adequately appreciated. Awareness of the unusual presentations in infants and older children and unpredictability and high mortality and morbidity associated with acute and chronic volvulus, surgical correction in the form of Ladd’s procedure is recommended in very patient with MM, regardless of age.