Abstract
Introduction Intestinal malrotation (IM) is characterized by abnormal intestinal rotation and
fixation predisposing to a risk of midgut volvulus. The aim of this study was to describe
the clinical presentation and outcome of IM from birth through childhood.
Materials and Methods This was a retrospective study of children with IM managed at a single center between
1983 and 2016. Data were retrieved from medical records and analyzed.
Results Three hundred nineteen patients were eligible for the study. Using strict inclusion
and exclusion criteria, 138 children were included. Vomiting was the most common symptom
up to 5 years of age. At 6 to 15 years of age, abdominal pain was the predominant
symptom. One hundred twenty-five patients underwent a Ladd's procedure and of 124
patients with available data, 20% had a postoperative complication (Clavien-Dindo
IIIb-V) within 30 days. The odds ratio to develop postoperative complications was
significantly increased in extremely preterm patients (p = 0.001) and in patients with severely affected intestinal circulation (p = 0.006). Two patients had intestinal failure due to midgut loss after midgut volvulus,
one of whom needed intestinal transplantation. Four patients, all extremely preterm,
died related to the surgical procedure. In addition, seven patients died of reasons
not related to IM. Fourteen patients (11%) had adhesive bowel obstruction and one
patient had recurrent midgut volvulus requiring surgical treatment.
Conclusions IM presents with different symptoms through childhood depending on age. Postoperative
complications are common after Ladd's procedure, particularly among extremely preterm
infants and patients with severely affected circulation caused by midgut volvulus.
Keywords
intestinal malrotation - intestinal rotation abnormalities - malrotation - midgut
volvulus
