Post- infantile presentation of intestinal malrotation

To study intestinal malrotation presenting after the age of one year, analyze the spectrum of presentations and to predict risk of volvulus. Retrospective study. Zagazig University Hospitals [Egypt] and King Fahd Hospital, Saudi Arabia. All cases [54] of malrotation during April 2006 to April 2010. Analysis of clinical, radiological and operative data. Presentation, significant associations and risk of volvulus. The mean age was 4.8 +/- 2.13 years. Presentations included acute volvulus [n = 27, 50%], chronic volvulus [4, 7.5%], mesocolic hernia [4, 7.5%], intussusception [5, 9%], exomphalos [5, 9%] and non-specific presentation [9, 17%]. Associated anomalies were found in 19 cases [35%] with significant association of chronic volvulus and exomphalos. Typical anatomical malrotation was seen in 21 [39%] cases with significant risk of volvulus [odds ratio 9.2]. Nausea and vomiting, abdominal colic, and malnutrition were dominant in acute and chronic volvulus, mesocolic hernia and intussusception [p < 0.05]. Malnutrition and gastroesophageal reflux disease [GERD] were significantly associated with chronic volvulus [p < 0.05]. Duodenal obstruction was significantly evident in acute volvulus while high cecum was dominant in intussusception. Prolonged ileus and persistent symptoms were significant in chronic volvulus and mesocolic hernia [p < 0.05], while wound infection and short bowel syndrome were significant in acute volvulus. Malrotation in the post-infantile period has a wide spectrum and non-specific presentation. Risk of midgut volvulus is present, especially in typical cases, and trials must be done to predict the risk and avoid unnecessary surgery

Value of abdominal pressure measurement in neonatal abdominal surgical emergencies

To assess the predictive and prognostic value of abdominal pressure measurement in neonatal abdominal surgical emergencies. Case series. Zagazig University Hospitals [Egypt] and King Fahd Hospital, Hofuf [KSA]. Seventy nine neonatal abdominal surgical emergencies admitted and managed over a four-year period [Jan 2005 to Jan 2009] Measurement of abdominal pressure through management period. Abdominal pressure was classified into pressure at presentation [T1], preoperative [T2], and postoperative pressure [T3]. The levels of pressure were classified into [pA] below 12 mmHg, [pB] 12-20 mmHg, and [pC] more than 20 mmHg. Seventy-nine neonates were included. There was significant high abdominal pressure in jejunoileal atresia, necrotizing enterocolitis [NEC], and duodenal obstruction. In pyloric stenosis, there was no significant abdominal hypertension all over the management period. Temporary elevations occurred preoperatively [T1] in meconium ileus, cecal perforation, and jejunal stenosis. Significant association was found between [T1] and mortality, postoperative blood transfusion, need for mechanical ventilation, and sepsis. No correlation was found with blood need or sepsis. Postoperative complications had significant association with elevated postoperative abdominal pressure [T3]. Intra-abdominal pressure [IAP] can be of importance in monitoring changes which accompany neonatal surgical emergencies. It can be of predictive and prognostic value in neonatal surgical emergencies. However, more controlled studies are needed to confirm this conclusion