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Eur J Pediatr Surg 2024; 34(01): 009-019
DOI: 10.1055/s-0043-1772173
Review Article

Neonatal Intestinal Segmental Volvulus: What Are the Differences with Midgut Volvulus?

Maria Casalino
1   Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
,
Maria Enrica Miscia
2   Pediatric Surgery Unit, University Gabriele d'Annunzio of Chieti Pescara Department of Medicine and Aging Science, Pescara, Italy
,
Giuseppe Lauriti
3   Department of Pediatric Surgery, Santo Spirito Hospital, University Gabriele d'Annunzio of Chieti and Pescara Department of Medicine and Aging Science, Chieti, Abruzzo, Italy
,
Estelle Gauda
4   Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Augusto Zani
5   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
6   Department of Surgery, University of Toronto, Toronto, Ontario, Canada
,
Elke Zani-Ruttenstock
5   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
› Author Affiliations
Funding None.
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Abstract

Objective Intestinal volvulus in the neonate is a surgical emergency caused by either midgut volvulus (MV) with intestinal malrotation or less commonly, by segmental volvulus (SV) without intestinal malrotation. The aim of our study was to investigate if MV and SV can be differentiated by clinical course, intraoperative findings, and postoperative outcomes.

Methods Using a defined search strategy, two investigators independently identified all studies comparing MV and SV in neonates. PRISMA guidelines were followed, and a meta-analysis was performed using RevMan 5.3.

Results Of 1,026 abstracts screened, 104 full-text articles were analyzed, and 3 comparative studies were selected (112 patients). There were no differences in gestational age (37 vs. 36 weeks), birth weight (2,989 vs. 2,712 g), and age at presentation (6.9 vs. 3.8 days). SV was more commonly associated with abnormal findings on fetal ultrasound (US; 65 vs. 11.6%; p < 0.00001). Preoperatively, SV was more commonly associated with abdominal distension (32 vs. 77%; p < 0.05), whereas MV with a whirlpool sign on ultrasound (57 vs. 3%; p < 0.01). Bilious vomiting had similar incidence in both (88 ± 4% vs. 50 ± 5%). Intraoperatively, SV had a higher incidence of intestinal atresia (2 vs. 19%; p < 0.05) and need for bowel resection (13 vs. 91%; p < 0.00001). There were no differences in postoperative complications (13% MV vs. 14% SV), short bowel syndrome (15% MV vs. 0% SV; data available only from one study), and mortality (12% MV vs. 2% SV).

Conclusion Our study highlights the paucity of studies on SV in neonates. Nonetheless, our meta-analysis clearly indicates that SV is an entity on its own with distinct clinical features and intraoperative findings that are different from MV. SV should be considered as one of the differential diagnoses in all term and preterm babies with bilious vomiting after MV was ruled out—especially if abnormal fetal US and abdominal distension is present.

Keywords

midgut volvulus - segmental volvulus - neonates - meta-analysis

Author Contributions Statement

M.C., G.L., E.Z.-R. contributed to conception/design, analysis and interpretation, participated in drafting. M.C., M.E.M. contributed to data acquisition. G.L., M.E.M. contributed to quality assessment. G.L., A.Z., E.G., E.Z.-R. participated in revision, and gave final approval.


Supplementary Material



Publication History

Received: 08 May 2023

Accepted: 04 July 2023

Article published online:
11 August 2023

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