Midgut malrotation in children: experience with 33 cases

ABSTRACT

Midgut marlrotation [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 infancy and nine [27%] after the first year of life. Seventy percent of patients presented with bilious vomiting. Although more common in neonates, acute volvulus occurs in all age groups. In patients presenting beyond the neonatal period the features of chronic/intermittent volvulus were more evident. Upper gastrointestinal contrast studies and ultrasound scan were the most commonly used investigations and were almost equally reliable. Awareness of unusual presentations in infants and older children and a high index of suspicion is recommended to avoid delayed diagnosis and surgical referral