Advances in Surgical Sciences
Volume 7, Issue 1, June 2019, Pages: 1-4
Received: Nov. 23, 2018;
Accepted: Jan. 21, 2019;
Published: Feb. 7, 2019
Views 84 Downloads 23
Samuel Chidi Ekpemo, Department of Surgery, Abia State University, Aba, Nigeria
Lisa Eweputanna, Department of Radiology, Abia State University, Aba, Nigeria
Emeka Nkwo, Department of Obstetrics and Gynaecology, Federal Medical Center, Umuahia, Nigeria
Background: The anomalies of rotation, migration and fixation of the intestines are of intense interest to the pediatric surgeon, as they are frequently associated with midgut volvulus which has catastrophic consequences when diagnosis is delayed or even not considered. This study evaluates the outcomes of surgical management of intestinal malrotation in children. Materials and Methods: The medical records of all patients with symptomatic malrotation, who underwent surgery between January 2010 and September 2018, were reviewed. Patients' demographic characteristics, clinical features management, complications, and outcome were evaluated. Results: Ten patients (nine boys and a girl) underwent surgery for malrotation at a median age of 3months. Eight presented with acute symptoms and two with chronic symptoms. All the patients had symptoms of intermittent or complete upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study in six of them. Volvulus was found at the time of surgery in 5 patients, three of whom were neonates. Eight patients were treated by Ladd's operation. Median length of stay was 10 days. One patient with massive bowel gangrene due to volvulus had right hemicolectomy. There was two perioperative death from anastomostic leak and septicaemia with an overall mortality of 20%. Conclusion: Bowel gangrene from volvulus contributes to mortality and small bowel adhesive intestinal obstruction is a cause of morbidity and mortality following surgery for intestinal malrotation. Neonates with bilious vomiting should raise the suspicion of malrotation until proven otherwise and given prompt intervention.
Samuel Chidi Ekpemo,
Childhood Intestine Rotation Anomalies in Aba, Nigeria, Advances in Surgical Sciences.
Vol. 7, No. 1,
2019, pp. 1-4.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mall FP. Development of human intestine and its position in adult. John Hopkins Hosp B 1896; 9:197-208.
Filston HC, Kirk DR. Malrotation, the ubiquitous anomaly. J pediatr Surg 1981; 16:614-620.
Dott NM. Anomalies of intestinal rotation: their embryology and surgical aspects with report of 5 cases. Br J Surg 1923; 11: 253-286
Ladd WE. Congenital obstruction of the duodenum in children. N Engl J Medicine 1932;206:297-283.
Gross E, Chen MK, Lobe TE: Laparoscopic evaluation and treatment of intestinal malrotation in infants. Surg Endosc 1996;10:936-937.
Strouse PJ. Disorders of intestinal rotation and fixation (“malrotation”). Pediatr Radiol 2004; 34:837–851
Amah CC, Agugua-Obianyo NEN, Ekenze SO. Intestinal malrotation in the older child: common diagnostic pitfalls. W Afr J Radiol 2004; 11:33–37
Ameh EA, Chirdan LB. Intestinal Malrotation: Experience in Zaria, Nigeria. WAJM 2001; 20, 227-30
Torres AM, Ziegler MM. Malrotation of the Intestine. World J Surg. 1993;17: 326-
Ameh EA, Nmadu PT. Intestinal volvulus:aetiology,morbidity and mortality in Nigerian children.Pediatr Surg Int 2000;16:50-52.
Reyes J, Bueno J, Kocoshis S, et al: Current status of intestinal transplantation in children. J Pediatr Surg 1998;33:243-254.
Bonadio WA, Clarkson T, Naus J. The clinical features of children with malrotation of the intestine. Pediatr Emerg Care 1991; 7:349
Rescorla FJ, Shedd FJ, Grosfeld JL, Vane DW, West KW: Anomalies of intestinal rotation in childhood: anomalies of 447 cases. Surgery 1990; 108:710-716.
Prarcos D, Sann L, Gein G, et al: Ultrasound diagnosis of midgut volvulus: the whirlpool sign. Pediatr Radiol 1992;22:18-20.
Dufour D, Delaet MH, Dassonville M, Cadranel S, Perlmutter N: Midgut malrotation, the reliability of sonographic diagnosis. Pediatr Radiol 1992; 22:21-23
Ashley LM, Allen S, Teele RL: A normal sonogram does not exclude malrotation. Pediatr Radiol 2001; 31:354-356.
Waugh GEA: The morbid consequences of a mobile ascending colon. Br J Surg 1920; 7:343,
Brerefon RJ, Taylor B, Hall CM: Intussception and intestinal malrotation in infants: Waugh’s syndrome. Br J Surg 1986; 73:55-57.
Spitz L, Orr JD, Harries JT: Obstructive jaundice secondary to chronic midgut volvulus. Arch Dis Child 1983;58:383-385.
Schwartz DL, So HB, Schneider KM, Becker JM: Recurrent chylous ascites associated with intestinal malrotation and lymphatic rupture. J Pediatr Surg 1983; 18:177-179.
Stauffer UG, Hermann P: Comparison of late results in patients with corrected intestinal malrotation with and without ﬁxation of the mesentery. J Pediatr Surg1980; 15:1.
Brennon WS, Bill AH: Prophylactic ﬁxation of the intestine for midgut non-rotation. Surg Gynecol Obstet 1974;138:181-184.