Outcome of Surgical Treatment of Malrotation in Children: A 20 Year Experience in A Tertiary Centre

Abstract

Pradyumna Pan, Girish Kumar Pathak

Aim: This study evaluated the clinical presentation, diagnostic evaluation, and outcomes of surgical management of intestinal malrotation in children.

Materials and Methods: The medical records of all neonates and children with a diagnosis of malrotation, who underwent surgery between January 2000 and December 2019, were retrospectively reviewed.

Results: A total of 96 patients, 59 males, underwent surgical correction for intestinal malrotation. The median age at surgery was 11.4 days (3 days –12 years). The most frequently observed symptom of malrotation was bilious vomiting. Diagnostic evaluations included upper gastrointestinal contrast study, Doppler ultrasound scanning of the mesenteric vessels, and oral contrast CT scan of the abdomen. All patients underwent surgical correction. Sepsis was the most common postoperative complication. The short gut syndrome was observed in 7. Mortality was observed in six (6.2%) patients.

Conclusion: Neonates uniformly presented with bilious emesis or other clinical and radiographic evidence of high small-bowel obstruction. The diagnosis of malrotation after childhood is difficult. Ultrasound with colour doppler can be used as a routine screening method. Malrotation with its predisposition for volvulus and vascular compromise demands prompt diagnosis and management.

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