Post- infantile presentation of intestinal malrotation

ABSTRACT

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