Background: Intestinal malrotation is one of the most common causes of bowel obstruction in neonates and presents with high intestinal obstruction and midgut volvulus. However, it can even present beyond infancy with atypical GI symptoms leading to a delay in diagnosis. Due to paucity of literature from Asian subcontinent, we were prompted to undertake this study.
Methods: We performed a retrospective analysis of all patients who were admitted with gut malrotation in childhood to department of pediatric surgery between 2006 and 2015. Patients were analyzed for their clinical presentation, radiological diagnosis, operative procedures and surgical outcomes. We excluded all the patients of midgut malrotation associated with congenital diaphragmatic hernia, gastroschsis or omphalocele.
Results: Of a total of 66 patients recruited, 36 were infants, 12 were children between 1 and 5 years of age, 11 were between 5 and 10 years and 7 were between 10 and 14 years of age. The sexratio(M:F) during neonatal age group was 2.2:1 and beyond neonatal period was 2.8:1. All infants presented with features of upper GI obstruction but presentation later in childhood was with atypical GI symptoms. Significant mesenteric lymphadenopathy was observed in some of the patients who presented late during childhood. The diagnosis was confirmed with X-ray abdomen, USG abdomen and contrast study of upper GI tract. All patients were subjected to surgical correction of malrotation with Ladd’s procedure. The mortality was 6% in present series.
Conclusion: Malrotation gut, although rare, must be kept in mind when dealing with patients in late childhood presenting with atypical GI symptoms and failure to thrive. Unlikewhat is considered traditionally, malrotation gut is not a “time bomb lying within” as the incidence of catastrophic complications like complete volvulus leading to gut gangrene beyond infancy is very minimal.