Abstract
Background/Purpose Malrotation with a common mesentery is the classical pathology allowing midgut volvulus
to occur. There are only a few reports of small bowel volvulus without malrotation
or other pathology triggering volvulation. We describe three cases of small bowel
volvulus in very premature newborns with a perfectly normal intra-abdominal anatomy
and focus on the question, what might have set off volvulation.
Methods In 2005 to 2008, three patients developed small bowel voluvulus without any underlying
pathology. Retrospective patient chart review was performed with special focus on
clinical presentation, preoperative management, intraoperative findings, and potential
causative explanations. Mean follow-up period was 46 months.
Results All patients were born between 27 and 31 weeks (mean 28 weeks) with a birth weight
between 800 and 1,000 g (mean 887 g). They presented with an almost identical pattern
of symptoms including sudden abdominal distension, abdominal tenderness, erythema
of the abdominal wall, high gastric residuals, and radiographic signs of ileus. All
of them were treated with intensive abdominal massage or pelvic rotation to improve
bowel movement before becoming symptomatic.
Conclusions Properistaltic maneuvers including abdominal massage and pelvic rotation may cause
what we term a “manufactured” volvulus in very premature newborns. Thus, this practice
was stopped.
Keywords
volvulus - premature newborns - malrotation - abdominal massage
