Intestinal Malrotation: An Insight in the Difficulties in the Diagnosis and Management
Journal Title: New Indian Journal of Surgery - Year 2017, Vol 8, Issue 1
Abstract
Backgound: Various clinical presentations, ranging from chronic abdominal pain to acute midgut volvulus with ischaemic bowel injury, may result from intestinal malrotation. In general it is possible to detect the intestinal malrotation, however there are many variables and exceptions. The purpose of this study was to retrospectively analyse the patients of intestinal malrotation at a single surgical centre in the last 10 years and to identify the spectrum of presentation, factors responsible for the delay affecting the diagnosis and outcome in these patients. Methods: The study was conducted in a tertiary referral centre with separated Department of Paediatric Surgery. Patients admitted and operated from July 2005 to July 2015 with complains of intestinal malrotation were included in this study. Case records were analysed with special emphasis on age, mode of presentation, any delay in treatment if any and the reason for it was noted. The operative records were retrieved to know the exact operative findings, the procedure performed and the outcome of surgery. Follow up was done for at least 1year, after surgery and postoperative complications if any were analysed. Results: Total 220 patients of intestinal malrotation were included in this study. Male were 143 and 77 were female. Neonates constituted the largest group (n=87) followed by infants (n=56). There 40 patients who had delay in diagnosis. Bilious vomiting was the commonest presentation (n=62/153) in early age group while chronic abdominal pain was seen in older age group (n=37/77). Ladd’s procedure was the commonest surgical procedure (n=167) followed by intestinal resection and stoma formation (n=28) and resection and anastomosis (n=21). There were 14 mortalities and 17 complications needing admission in follow-up period of 1 year. Conclusion: Intestinal malrotation is a surgical problem mostly of neonates but it is more likely to be ignored in older children who are otherwise being treated for some unrelated conditions and continue to develop chronic abdominal pain and intermittent distension, and poor growth. A high index of clinical suspicion is needed especially in these patients. The problem if not diagnosed properly leads to bowel loss, increased morbidity and mortality.
Authors and Affiliations
Tanvir Roshan Khan
Keywords
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- EP ID EP470218
- DOI 10.21088/nijs.0976.4747.8117.4
- Views 97
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