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Ahmed M, Habib M, Memon H, Ahmad RR, Chaudhary MA. Presentations of Waugh's syndrome:intra-luminal cecal cyst and trans-anal prolapsing intussusception: a case report. J Med Case Rep 2024; 18:376. [PMID: 39155375 PMCID: PMC11331647 DOI: 10.1186/s13256-024-04701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/28/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Intussusception with intestinal malrotation is termed as Waugh's syndrome. The incidence of Waugh's syndrome is less than 1%. There are very few reported cases. Once presented, it is a pediatric surgical emergency. CASE PRESENTATION We present here two cases of Waugh's syndrome: an 11-month-old male patient of Punjabi descent and a 4-month-old female patient of Afghan descent who presented to us with abdominal pain and bleeding per rectum. Abdominal sonography revealed an intussusception with a target sign. They were explored and perioperatively had intestinal malrotation alongside intussusception, thus a diagnosis of Waugh's syndrome was made. A right hemicolectomy and Ladd's procedure was performed. CONCLUSION Waugh syndrome is a rare congenital anomaly but can present with vague abdominal symptoms. Once presented, it is a pediatric surgical emergency. The patient should be optimized followed by surgical exploration.
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Affiliation(s)
- Mansoor Ahmed
- Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, 44000, Pakistan.
| | - Murad Habib
- Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, 44000, Pakistan
| | - Huma Memon
- Department of Paediatric Medicine, The Children's Hospital, Pakistan Institute of Medical Sciences Islamabad/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, 44000, Pakistan
| | - Rafee Raza Ahmad
- Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, 44000, Pakistan
| | - Muhammad Amjad Chaudhary
- Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, 44000, Pakistan
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Afasha K, Alabdulwahid N, Dawood A. Waugh's Syndrome in an Adult Patient: A Case Report and a Review of the Literature. Cureus 2024; 16:e51786. [PMID: 38322060 PMCID: PMC10846346 DOI: 10.7759/cureus.51786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Waugh's syndrome is a rare disease that typically presents as acute-onset intussusception caused by gut malrotation. This disease, while generally reported during infancy or childhood, can also affect adults. This case report describes the rare case of Waugh's syndrome in an adult with cystic fibrosis. The patient, a 19-year-old male, was admitted one week after the onset of pain and distention in the abdomen, with vomiting alternating with constipation. He had visited emergency rooms in the past and was taking symptomatic treatment, but on arrival at our facility, he developed a tonic-colonic convulsion. The evaluation showed respiratory acidosis, severe hyponatremia, and abdominal distension with an empty rectum. The patient was discovered to have colo-colonic intussusception by imaging, and he was admitted into the intensive care unit before exploratory surgery. Surgical findings showed intestinal malrotation with the cecum lying in the left upper quadrant and ilio-colic intussusception extending to the mid-rectum. A distal ileal resection was required for partial reduction, leaving a residual segment needing an ileostomy. Histopathology performed after surgery found a blocked lumen, edema hemorrhage, and necrosis. Following discharge, the patient's recovery was hampered by a high-volume stoma. He had to be readmitted for electrolyte correction and hydration as well as preparation of the normal passage of foods through his system. Later follow-up showed that the output of the stoma had been brought under control, and nutritional status greatly improved. The patient planned to have a stoma reversal after three months. This case emphasizes the need for a multidisciplinary approach to treating Waugh's syndrome in adult patients.
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Affiliation(s)
- Khaled Afasha
- General Surgery, King Abdulaziz Hospital and Oncology Center, Jeddah, SAU
| | - Nada Alabdulwahid
- General Surgery, King Abdulaziz Hospital and Oncology Center, Jeddah, SAU
| | - Atif Dawood
- General Surgery, King Abdulaziz Hospital and Oncology Center, Jeddah, SAU
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Carmine N, Salvatore C, Mercedes R, Stefano N, Alfonso P. Transanal protrusion of intussusception can be sign of Waugh syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Manekar AA, Janjala N, Sahoo SK, Tripathy BB, Mohanty MK. Recurrent intussusception as a rare clinical manifestation of intestinal malrotation in children—a case report and review of literature. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mobile caecum along with malfixed small bowel mesentery in malrotation is incriminated to cause intussusception in children. This dual association is very rare and is labeled as Waugh’s syndrome. This is often missed during conservative management of intussusception and may manifest as chronic intussusception.
Case presentation
We report a rare case of intestinal malrotation in a 13-year-old boy who presented as recurrent intussusception. The child was resuscitated and was operated, where malrotation of gut was detected. We discuss the clinical presentation, radiological findings, and management of this rare association in light of current available literature.
Conclusion
The presence of mobile caecum and redundant bowel loops with narrow mesentery in case of malrotation is an important factor leading to intussusception.
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Mazingi D, Burnett E, Mujuru HA, Nathoo K, Tate J, Mwenda J, Weldegebriel G, Manangazira P, Mukaratirwa A, Parashar U, Zimunhu T, Mbuwayesango BA. Delays in presentation of intussusception and development of gangrene in Zimbabwe. Pan Afr Med J 2021; 39:3. [PMID: 34548895 PMCID: PMC8437425 DOI: 10.11604/pamj.supp.2021.39.1.21301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/26/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction prompt diagnosis and treatment are considered key to successful management of intussusception. We examined pre-treatment delay among intussusception cases in Zimbabwe and conducted an exploratory analysis of factors associated with intraoperative finding of gangrene. Methods data were prospectively collected as part of the African Intussusception Network using a questionnaire administered on consecutive patients with intussusception managed at Harare Children´s Hospital. Delays were classified using the Three-Delays-Model: care-seeking delay (time from onset of symptoms to first presentation for health care), health-system delay (referral time from presentation to first facility to treatment facility) and treatment delay (time from presentation at treatment facility to treatment). Results ninety-two patients were enrolled from August 2014 to December 2016. The mean care-seeking interval was 1.9 days, the mean health-system interval was 1.5 days, and the mean treatment interval was 1.1 days. Mean total time from symptom onset to treatment was 4.4 days. Being transferred from another institution added 1.4 days to the patient journey. Gangrene was found in 2 (25%) of children who received treatment within 1 day, 13 (41%) of children who received treatment 2-3 days, and 26 (50%) of children who received treatment more than 3 days after symptom onset (p = 0.34). Conclusion significant care-seeking and health-system delays are encountered by intussusception patients in Zimbabwe. Our findings highlight the need to explore approaches to improve the early diagnosis of intussusception and prompt referral of patients for treatment.
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Affiliation(s)
| | | | | | - Kusum Nathoo
- Department of Pediatrics and Child Health, University of Zimbabwe, Zimbabwe
| | | | - Jason Mwenda
- World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Goitom Weldegebriel
- World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Portia Manangazira
- Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Arnold Mukaratirwa
- Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, USA
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Waugh’s Syndrome (Malrotation Causing Intussusception)—Very Rare Presentation in Adults. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02385-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hasan Z, Thakur VK, Chaubey D, Yadav R. Post-operative Intussusception Following Ladd’s Procedure. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kakiuchi T, Nakayama A, Nojiri J, Yamanouchi T, Matsuo M. Jejuno-jejunal intussusception caused by a percutaneous endoscopic gastrojejunostomy tube in a pediatric patient: A case report. Medicine (Baltimore) 2020; 99:e19888. [PMID: 32312016 PMCID: PMC7220696 DOI: 10.1097/md.0000000000019888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Although percutaneous endoscopic gastrojejunostomy (PEG-J) tubes are believed to reduce the side effect of aspiration, cautious catheter management is required. Intussusception is a serious complication of these tubes. PATIENT CONCERNS A 7-year-old boy bedridden with hypoxic encephalopathy owing to drowning at the age of 1 year was admitted our hospital with urinary retention for 1 month. At the age of 4 years, a PEG-J tube was inserted. Concomitant with hyperaldosteronemia, an intestinal intussusception from the duodenum to the jejunum was observed via computed tomography (CT). The patient's condition worsened dramatically; gastrointestinal perforation was suspected, and laparotomy was performed. DIAGNOSIS Jejuno-jejunal intussusception. INTERVENTIONS Open surgery was performed to release the intussusception. By assessing the reduced intestinal tract, the intussusception starting from a 50 cm portion from the Treitz ligament had been extended to 100 cm from the Treitz ligament. The oral side jejunum was dilated. No evidence of intestinal perforation or strangulated ileus was observed, and the intussusception was manually remediable. OUTCOMES Preoperative CT examination showed intussusception from the duodenum to the jejunum. Laparotomy showed intussusception on the anal side of the Treitz ligament. With regard to the CT findings associated with the progression of intussusception to the duodenal site, as a result of the telescope phenomenon extending to the duodenum due to the relaxation of the Treitz ligament through repeated intussusception, it was considered that CT examination revealed intussusception extending from the jejunum to the duodenum of oral side. After 3 postoperative weeks, the patient was finally able to return home. LESSONS If the ileus is observed during the insertion of a PEG-J, clinicians should consider the possibility of intussusception even in the duodenum.
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Affiliation(s)
| | | | - Junichi Nojiri
- Department of Radiology, Faculty of Medicine, Saga University
| | - Takeshi Yamanouchi
- Department of Pediatric Surgery, Saga-Ken Medical Center Koseikan, Saga, Japan
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Kubo H, Koda Y, Ishikawa Y. Intussusception following the Ladd procedure for malrotation. Pediatr Int 2019; 61:926-927. [PMID: 31569292 DOI: 10.1111/ped.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/09/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroyuki Kubo
- Departments of, Pediatric Surgery, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
| | - Yusuke Koda
- Gastroenterological Surgery, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
| | - Yasuhide Ishikawa
- Gastroenterological Surgery, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
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Volvulus of the ascending colon due to failure of zygosis: A case report and review of the literature. Int J Surg Case Rep 2019; 59:90-93. [PMID: 31125788 PMCID: PMC6531863 DOI: 10.1016/j.ijscr.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/20/2019] [Accepted: 05/08/2019] [Indexed: 01/19/2023] Open
Abstract
The ascending colon has been described as a retroperitoneal organ however it may occasionally have a long mesentery. The process of peritoneal zygosis is incompletely understood and is subject to perturbation leading to many abnormalities. The excessive mobility may predispose to volvulus of this intestinal segment. There is often a long symptomatic prodrome before volvulus occurs during which the observant surgeon may intervene. The mesentery has gained new relevance with respect to its role in the contemporary management of surgical diseases.
Introduction Volvulus of the mobile ascending colon is a serious complication of a subtle embryological abnormality that frequently goes unrecognised. There has been renewed interest in the development of the mesentery because of its relevance to the contemporary management of surgical diseases. This case is presented to illustrate the dire consequences of missing this diagnosis and to review the fascinating embryology of the condition as well as its clinical implications. Presentation of case We report on a 23-year-old male who presented with signs and symptoms of distal small bowel obstruction after a long prior history of intermittent right lower quadrant pain. At laparotomy, a 360-degree counter-clockwise volvulus of the entire right colon was noted as the result of an excessively long ascending mesocolon and unattached hepatic flexure. All gangrenous bowel was resected with primary ileocolic anastomosis performed thereafter. The patient did well post-operatively and was subsequently discharged. Discussion Interruption of the in-utero events of fixation known as peritoneal zygosis lead to a persistence of the mesocolon in parts of the bowel that ordinarily are retroperitoneal. The events that lead to this anomaly are poorly understood and have been subject to controversy for centuries. New insights have challenged surgical dogma and informed new surgical techniques. Its true incidence is probably underestimated because of its indolent clinical prodrome, and it requires a high index of suspicion. Conclusion Failure of peritoneal zygosis is implicated in a myriad of clinical conditions. Expeditious recognition and intervention in the prodromal period can avert potentially disastrous complications.
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Pediatric ileocolic intussusception: new observations and unexpected implications. Pediatr Radiol 2019; 49:76-81. [PMID: 30232533 DOI: 10.1007/s00247-018-4259-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/23/2018] [Accepted: 09/03/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ileocolic intussusception occurs when the terminal ileum "telescopes" into the colon. We observed that ileocolic intussusception lengths are similar regardless of location in the colon. OBJECTIVE To examine the uniformity of ileocolic intussusception length and its relationship to colon location, symptom duration and reducibility. MATERIALS AND METHODS We retrospectively reviewed ultrasound-diagnosed pediatric ileocolic intussusceptions initially treated with pneumatic reduction at the Mayo Clinic or Texas Children's Hospital. We recorded demographic, imaging and surgical findings including age, gender, symptom duration, location of the ileocolic intussusception, reducibility with air enema and, if fluoroscopically irreducible, surgical findings. RESULTS We identified 119 ileocolic intussusceptions (64% boys), with 81% in the right colon. There was no significant relationship between ileocolic intussusception length and colon location (P=0.15), nor ileocolic intussusception length and symptom duration (P=0.36). Ileocolic intussusceptions were more distal with increasing symptom duration (P=0.016). Successful reductions were unrelated to symptom duration (P=0.84) but were more likely with proximal versus distal locations (P=0.02). CONCLUSION Ileocolic intussusception lengths are relatively uniform regardless of location along the course of the colon where they present. Our findings suggest that most of the apparent distal propagation of ileocolic intussusceptions is not caused by increasing telescoping of small bowel across the ileocecal valve but rather by foreshortening of the right colon. This implies poor cecal fixation and confirms fluoroscopic and surgical observations of cecal displacement from the right lower quadrant with ileocolic intussusceptions. The movement of the leading edge of the ileocolic intussusception during reduction is first due to "relocating" the cecum into the right lower quadrant after which the reduction of small bowel back across the ileocecal valve then occurs.
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Khan YA, Yadav SK, Elkholy A. Waugh's Syndrome: Report of Two Children with Intussusception. European J Pediatr Surg Rep 2017; 5:e29-e31. [PMID: 28761799 PMCID: PMC5533607 DOI: 10.1055/s-0037-1604264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/10/2017] [Indexed: 11/04/2022] Open
Abstract
Waugh's syndrome (WS) is the rare association of intussusception and intestinal malrotation. We present two such cases in a 5-month-old infant and a 9-year-old girl. Both patients presented with intussusception and were diagnosed with malrotation during workup and surgical exploration. We conclude that the possibility of intestinal malrotation must be taken into consideration while managing children with intussusception.
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Affiliation(s)
- Yousuf Aziz Khan
- Department of Paediatric Surgery, Ibn Sina Specialized Surgical Hospital, Al-Sabah Health Region, Safat, Kuwait, Kuwait, Kuwait
| | - Sunil Kumar Yadav
- Department of Paediatric Surgery, Ibn Sina Specialized Surgical Hospital, Al-Sabah Health Region, Safat, Kuwait, Kuwait, Kuwait
| | - Ashraf Elkholy
- Department of Paediatric Surgery, Ibn Sina Specialized Surgical Hospital, Ibn Sina Hospital Ministry of Health, Kuwait, Kuwait, Kuwait.,Department of Pediatric Surgery, Kasr Elaini School of Medicine Cairo University, Kasr Elainy Faculty of Medicine, Cairo, Cairo, Egypt
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Tripathy PK, Jena PK. Colocolic Intussusception in a Child with Pathologic Lead Point Along with Intestinal Malrotation-A Rare Case Report and Brief Review. J Clin Diagn Res 2017; 10:PD09-PD10. [PMID: 28208929 DOI: 10.7860/jcdr/2016/22049.9068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
Abstract
Intestinal obstruction in children is frequently caused by intussusception and intestinal malrotation and when these two conditions co-exist, it is called Waugh's syndrome. Intussusception cases in children are mostly ileocolic, whereas, the colocolic variety is a rare entity and very few cases have been reported in literature. In all the reported cases of Waugh's syndrome, the intussusceptions were ileocolic type except one case, where colocolic type was mentioned with lymphangoima as Pathological Lead Point (PLP). We report a seven-year-old child of colocolic intussusception with juvenile polyp being the PLP along with intestional malrotation. It is an extremely rare association which has not been reported previously.
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Affiliation(s)
- Prasanta Kumar Tripathy
- Assistant Professor, Department of Pediatric Surgery, SVP Post Graduate Institute of Pediatrics , Cuttack, Odisha, India
| | - Pradeep Kumar Jena
- Professor, Department of Pediatric Surgery, SVP Post Graduate Institute of Pediatrics , Cuttack, Odisha, India
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14
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Chronic Intussusception Associated with Malrotation in a Child: A Variation of Waugh's Syndrome? Case Rep Surg 2016; 2016:5638451. [PMID: 27777808 PMCID: PMC5061943 DOI: 10.1155/2016/5638451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/14/2016] [Indexed: 11/26/2022] Open
Abstract
Chronic intussusception is a relatively uncommon disease most commonly observed in older children. Waugh's syndrome represents a rare entity characterized by intestinal malrotation and acute intussusception. We report a very unusual case of intestinal malrotation associated with chronic intussusception. Clinical presentation, radiological findings, and managing of this association are discussed in the light of the available literature.
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Abstract
Chronic intussusception as a cause of persistent abdominal pain in children is often an overlooked diagnosis. Here we present an eight-year-old boy, who at the age of three years had an acute intussusception reduced hydrostatically with barium and who subsequently had been extensively investigated both in Wales and in Switzerland, for persistent colicky abdominal pain. He was found to have chronic intussusception, with a Meckel’s diverticulum being the cause of his symptoms.
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Affiliation(s)
- N J West
- Princess Royal Hospital, Haywards Heath, West Sussex RH16 4EX, England
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Affiliation(s)
- Scott A Cameron
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michael A Gittelman
- Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH
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Chan CYG, Tsang PKJ, Chu PY, Wong YC. Rare presentation of small bowel intussusception in childhood. Pediatr Int 2016; 58:642-5. [PMID: 27117717 DOI: 10.1111/ped.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 12/07/2015] [Accepted: 12/24/2015] [Indexed: 11/30/2022]
Abstract
Small bowel intussusception complicated simultaneously by volvulus in an older child is rare but clinically significant, necessitating urgent operative management. We report a local case of jejuno-jejunal intussusception complicated by volvulus and bowel infarction in a 9-year-old Chinese girl, with diagnosis made on preoperative computed tomography and confirmed at laparotomy. An intestinal polyp as the lead point for intussusception was identified operatively.
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Affiliation(s)
- Chung-Yan Grace Chan
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - Pui-Ki Jane Tsang
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ping-Yung Chu
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - Yiu-Chung Wong
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, New Territories, Hong Kong
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Oberle D, Jenke AC, von Kries R, Mentzer D, Keller-Stanislawski B. Rotavirus vaccination: a risk factor for intussusception? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:234-41. [PMID: 24469287 DOI: 10.1007/s00103-013-1893-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recently published pharmacoepidemiological studies associate the currently authorized Rotavirus (RV) vaccines with intussusception (IS). We aimed at investigating whether, in Germany, there are excess IS cases in RV vaccinees compared with the background incidence before market authorization in 2006. Suspected cases of IS following receipt of RV vaccines reported to the Paul-Ehrlich-Institut (PEI) from 2006 to 2010 were reviewed and validated against the criteria of the Brighton Collaboration's definition for IS. An observed-versus-expected analysis was conducted using standardized morbidity ratio (SMR) methods based on age-specific incidence rates for IS ranging from 19.2 to 98.5 per 100,000 person-years. A total of 27 cases of suspected IS in RV vaccinees were reported to the PEI. No excess of IS cases could be detected 1-7 days after receipt of either RV vaccine after any dose in the first year of life; however, in infants aged 3-5 months, a significantly increased SMR for IS was found in a risk window of 1-7 days after the first dose of either RV vaccine [SMRs: Rotarix® 4.6 (95% CI 1.5-10.7); RotaTeq® 5.8 (95% CI 1.2-17.1)]. A significantly increased risk of IS in a risk window of 1-7 days after RV vaccination was not found when the first dose was administered earlier. Therefore, it is recommended to start the vaccination course at 6-12 weeks of age.
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Affiliation(s)
- D Oberle
- Referat Pharmakovigilanz S1, Federal Institute for Vaccines and Biomedicines (Paul-Ehrlich-Institut), Paul-Ehrlich-Str. 51-59, 63225, Langen, Germany,
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20
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Sinha CK, Basson S, Patel RV, Mathur AB. Norwich paediatric triad: malrotation, intussusception and small intestinal lymphoma. BMJ Case Rep 2014; 2014:bcr-2013-201110. [PMID: 25432904 DOI: 10.1136/bcr-2013-201110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- C K Sinha
- Department of Paediatric Surgery, NNUH, Norwich, UK
| | - S Basson
- Department of Paediatric Surgery, NNUH, Norwich, UK
| | - R V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A B Mathur
- Department of Paediatric Surgery, NNUH, Norwich, UK
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Abstract
BACKGROUND AND OBJECTIVES Waugh syndrome (WS) is the association of intussusception and intestinal malrotation. The association is rarely reported in the literature though intussusception is a commonly encountered problem in pediatric patients as a cause of intestinal obstruction. We present our experience in 7 patients with a review of published reports. DESIGN AND SETTING Retrospective analysis of 7 patients with the diagnosis of Waugh syndrome who were treated at our department between February 1982 to December 2012. PATIENTS AND METHODS Seven patients with Waugh syndrome presented to our unit during the period February 1982 to December 2012. The clinical findings and management are presented and discussed. RESULTS Seven patients (three males and four females) presented with intussusception in association with mal.rotation. The age range was from 4 to 11 months; the patients had bilious vomiting and blood in the stool; the diagnosis was confirmed by ultrasound (2), Ba enema (2) and intraoperatively (3). All required operative intervention; either manual reduction or bowel resection and Ladd procedure; one patient died of sepsis; recurrence of obstruction was seen in another patient while the rest did well postoperatively. CONCLUSION The relationship between intestinal malrotation and intussusceptions may be more frequent than is reported; failure of non-operative management of intussusception may be due to this association and hence brings the attention to its existence. A prospective study is needed to look for intestinal malrotation in patient with intussusceptions who undergo abdominal sonographic examination to determine the true incidence of this association. The anomaly is suspected by presence of a reversed anatomic relationship of the superior mesenteric artery and vein and in such cases to perform an upper gastrointestinal contrast study to define the exact location of the duodenojejuonal (DJ).
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Affiliation(s)
- Hashem Al-Momani
- Hashem Al-Momani, MD, Department of General Surgery,, University of Jordan, PO Box 13764 Amman, 11942 Jordan, T: +96265353444,
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A case of intussusception with internal hernia after surgery for malrotation and duodenal atresia in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chaudhary P, Rao M, Arora MP. Waugh's syndrome in an adult: report of a very rare disease. Clin Pract 2012; 2:e78. [PMID: 24765477 PMCID: PMC3981322 DOI: 10.4081/cp.2012.e78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/18/2012] [Accepted: 07/05/2012] [Indexed: 12/04/2022] Open
Abstract
The authors report a case of Waugh's syndrome in an adult. Waugh's syndrome is rare in adults as most of the cases present in paediatric age group. We have discussed treatment options and it is suggested that the possibility of Waugh's syndrome should always be kept in mind when a case of intussusception is being treated by either operative or non-operative method.
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Affiliation(s)
- Poras Chaudhary
- Department of General Surgery, Lady Hardinge Medical College and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Meenakshi Rao
- Department of General Surgery, Lady Hardinge Medical College and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Moninder P Arora
- Department of General Surgery, Lady Hardinge Medical College and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Baltazar G, Sahyoun C, Sime J, Bitar M, Bitar J, Rao AC. Discovery of a case of Waugh's syndrome during a mission to Haiti. Int J Surg Case Rep 2011; 3:22-4. [PMID: 22288034 DOI: 10.1016/j.ijscr.2011.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/09/2011] [Accepted: 09/16/2011] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION A rarely reported entity, Waugh's syndrome is the association between intestinal malrotation and intussusception. We present a case of Waugh's syndrome encountered during a medical mission to a resource poor country. PRESENTATION OF CASE A 3-month-old female presented with septic shock and acute bowel obstruction secondary to intussusception and malrotation. She required aggressive resuscitation and emergent laparotomy, bowel resection, Ladd procedure and temporary ileostomy. DISCUSSION First described in 1911, Waugh's syndrome has been rarely reported in the literature. We summarize a total of 54 cases of Waugh's syndrome that are reported in the literature to date. The complicated but successful care of this patient reflects the severe outcome of any inadequate treatment of Waugh's syndrome and illustrates the importance of medical volunteers in developing countries. CONCLUSION As the relationship between malrotation and intussusception may be more frequent than recorded, surgeons must be aware that non-operative management of intussusception may be inadequate therapy.
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Affiliation(s)
- Gerard Baltazar
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn, NY, United States
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Affiliation(s)
- Garret Harper
- Emory University Department of Plastic Surgery Atlanta, Georgia
| | - David Hardy
- Medical College of Georgia Children's Medical Center Department of Pediatric Surgery Augusta, Georgia
| | - Charles Howell
- Medical College of Georgia Children's Medical Center Department of Pediatric Surgery Augusta, Georgia
| | - Robyn Hatley
- Medical College of Georgia Children's Medical Center Department of Pediatric Surgery Augusta, Georgia
| | - Walter Pipkin
- Medical College of Georgia Children's Medical Center Department of Pediatric Surgery Augusta, Georgia
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Loukas M, Pellerin M, Kimball Z, de la Garza-Jordan J, Tubbs RS, Jordan R. Intussusception: An anatomical perspective with review of the literature. Clin Anat 2011; 24:552-61. [DOI: 10.1002/ca.21099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 08/10/2010] [Accepted: 10/25/2010] [Indexed: 12/24/2022]
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Al-Jahdali A, Lees GM, Gay DP, Al-Sairafi R. Colocolic intussusception in a preterm infant with intestinal malrotation. J Pediatr Surg 2009; 44:e17-8. [PMID: 20005997 DOI: 10.1016/j.jpedsurg.2009.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/14/2009] [Accepted: 09/18/2009] [Indexed: 11/16/2022]
Abstract
The association of intussusception and intestinal malrotation is referred to as Waugh syndrome. A prospective study among 49 children with intussusception found a 40% incidence of malrotation. We describe the rare occurrence of colocolic intussusception in a neonate with malrotated intestine. We believe this is the first reported case in the neonatal period where the pathogenic lead point was an intestinal lymphangioma.
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Affiliation(s)
- Akram Al-Jahdali
- Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada T6R 0B5.
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29
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Combination of adult intussusception and intestinal malrotation: an unusual presentation. Dig Dis Sci 2008; 53:3037-9. [PMID: 18797992 DOI: 10.1007/s10620-008-0530-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 06/29/2006] [Indexed: 01/26/2023]
Abstract
Intussusception is familiar to pediatric surgeons but is rarely encountered by general surgeons. Adult intussusception is uncommon, accounting for less than 5% of intestinal obstructions, half of which are associated neoplasms. Intestinal malrotation is usually an incidental finding with unrelated disease on image studies, laparotomy or even autopsy. The major complications of intestinal malrotation are intestinal obstruction secondary to midgut volvulus, internal hernia, or adhesion band. The association of the two entities, which is named Waugh's syndrome in infants, has rarely been reported in the literature. The association in adults is even rarer. We report an adult case with an unusual combination of malrotation and intussusception at exploration.
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Abstract
PURPOSE Intussusception is one of the common causes of intestinal obstruction in early childhood. Although a genetic predisposition has been suggested in some cases, its etiology is considered to be incidental, and it has not been traditionally regarded as having any genetic basis. Authors report on cases of so-called idiopathic intussusception that demonstrate a strong familial tendency. MATERIALS We reviewed medical records of idiopathic intussusception reduced in our institute between 1975 and 2004. There were 564 patients. Their parents and/or grandparents were interviewed directly or by telephone about the occurrence of familial intussusception. RESULTS A family history of idiopathic intussusception, including third-degree relatives, was noted on 39 pedigrees. Occurrences between father and son were 1, mother and son 4, mother and daughter 2, mother and son and daughter 1 (sibling), siblings 10, sibling and cousin 1, uncle or aunt and nephew or niece 6, uncle and nephew and niece (cousin) 1, and cousins 13. Among 564 patients with idiopathic intussusception, 20 patients, both of 6 pairs of siblings and both of 4 pairs of cousins were treated in our institute. So in 554 pedigrees of idiopathic intussusception, the incidence of familial intussusception, including third-degree relatives, was estimated to be 7.0% or 1 in 14.2 cases. CONCLUSION We concluded that hereditary predisposition, such as anatomical basis, may be considered as an etiological factor in many cases of idiopathic intussusception. In these predisposed families, if they have inducements such as viral infections as the acquired agents, intussusception will occur very easily.
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Affiliation(s)
- Takehito Oshio
- Department of Pediatric Surgery, National Kagawa Children's Hospital 2603, Kagawa-ken 765-8501, Japan.
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Gardner-Thorpe J, Hardwick RH, Carroll NR, Gibbs P, Jamieson NV, Praseedom RK. Adult duodenal intussusception associated with congenital malrotation. World J Gastroenterol 2007; 13:3892-4. [PMID: 17657849 PMCID: PMC4611227 DOI: 10.3748/wjg.v13.i28.3892] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Enteroenteric intussusception is a condition in which full-thickness bowel wall becomes telescoped into the lumen of distal bowel. In adults, there is usually an abnormality acting as a lead point, usually a Meckels' diverticulum, a hamartoma or a tumour. Duodeno-duodenal intussusception is exceptionally rare because the retroperitoneal situation fixes the duodenal wall. The aim of this report is to describe the first published case of this condition. A patient with duodeno-duodenal intussusception secondary to an ampullary lesion is reported. A 66 year-old lady presented with intermittent abdominal pain, weight loss and anaemia. Ultrasound scanning showed dilated bile and pancreatic ducts. CT scanning revealed intussusception involving the full-thickness duodenal wall. The lead point was an ampullary villous adenoma. Congenital partial (type II) malrotation was found at operation and this abnormality permitted excessive mobility of the duodenal wall such that intussusception was possible. This condition can be diagnosed using enhanced CT. Intussusception can be complicated by bowel obstruction, ischaemia or bleeding, and therefore the underlying cause should be treated as soon as possible.
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Affiliation(s)
- J Gardner-Thorpe
- Cambridge Surgical HPB Unit, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 2QQ, United Kingdom
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Gasparini FF, Navarro OM, Dasgupta R, Gerstle JT, Thorner PS, Manson DE. Ileocolic intussusception mimicking the imaging appearance of midgut volvulus as a result of extrinsic duodenal obstruction. Pediatr Radiol 2005; 35:1246-9. [PMID: 16096826 DOI: 10.1007/s00247-005-1563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 07/05/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
Duodenal obstruction caused by ileocolic intussusception in the absence of intestinal malrotation is extremely rare. We present and discuss the imaging findings in an infant with an intussusception secondary to a duplication cyst in whom sonography also showed inversion of the orientation of the mesenteric vessels and a distended stomach. A contrast medium study revealed a proximal duodenal obstruction with a beak appearance suggestive of midgut volvulus. At surgery, an ileocolic intussusception causing duodenal obstruction without concomitant malrotation or volvulus was found. The combination of duodenal obstruction and abnormal relationship of the mesenteric vessels as a result of ileocolic intussusception has not previously been reported in the literature.
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Affiliation(s)
- Flavia F Gasparini
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, 555 University Ave., Ontario, M5G 1X8, Toronto, Canada
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Dawrant MJ, Lee JC, Ho CP, De Caluwé D. Complex presentation of intussusception in childhood. Pediatr Surg Int 2005; 21:730-2. [PMID: 15977016 DOI: 10.1007/s00383-005-1463-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2004] [Indexed: 01/30/2023]
Abstract
The simultaneous occurrence of intussusception and volvulus in the paediatric age group is rare. We report the case of a volvulus of an ileoileal intussusception in an 8-year-old boy. This is the first time that computerised tomography (CT) images of a volvulus of an ileoileal intussusception have been published, and they clearly demonstrate both pathologies. This case highlights the use of CT in determining the nature of an abdominal mass and demonstrates how helpful it can be in diagnosing the cause of small bowel obstruction in children.
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Affiliation(s)
- M J Dawrant
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, 369, Fulham Road, London, SW109NH, UK
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34
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Strouse PJ. Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol 2004; 34:837-51. [PMID: 15378215 DOI: 10.1007/s00247-004-1279-4] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Accepted: 06/15/2004] [Indexed: 11/29/2022]
Abstract
Malrotation with volvulus is one of the true surgical emergencies of childhood. Prompt radiological diagnosis is often paramount to achieving a good outcome. An understanding of the normal and anomalous development of the midgut provides a basis for understanding the pathophysiology and the clinical presentation of malrotation and malrotation complicated by volvulus. In this essay, the radiologic findings of malrotation and volvulus are reviewed and illustrated with particular attention to the child with equivocal imaging findings.
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Affiliation(s)
- Peter J Strouse
- Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Medical Center, 1500 East Medical Center Drive, MI, Ann Arbor 48109-0252, USA.
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Abstract
The association of intussusception and intestinal malrotation has been reported rarely in the literature. This association is called Waugh's syndrome. The authors report 2 cases of Waugh's syndrome and discuss diagnostic features and treatment methods.
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Affiliation(s)
- Mustafa Inan
- Faculty of Medicine, Department of Pediatric Surgery, Trakya University, Edirne, Turkey
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Abstract
The subject of malrotation and midgut volvulus in infancy and childhood is reviewed from the perspective of experience with 138 patients evaluated in a published series and a further 82 cases seen since. Embryology, historical aspects, clinical presentation, investigation, surgery, and outcome are discussed. The diagnosis of malrotation and volvulus should always be kept in mind when assessing any infant or child with symptoms of vomiting and pain, particularly when the vomiting is bile-stained. The diagnosis cannot be excluded if diarrhea is present, when clinical findings are bland, or even with normal abdominal radiographs. A contrast meal and follow-through should be done and, if correctly interpreted, should be diagnostic. Ultrasound examination may be helpful but is not secure enough to exclude the diagnosis. Laparotomy or laparoscopy is the only way to be sure. Malrotation with its propensity for volvulus is truly a time bomb lying within.
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Affiliation(s)
- A J W Millar
- Department of Paediatric Surgery, School of Child and Adolescent Health, University of Cape Town and Red Cross Children's Hospital, Rondesbosch, South Africa
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38
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Abstract
Malrotation of the intestinal tract is a product of a well defined aberrant embryology. Because the consequences of malrotation associated with a midgut volvulus may be catastrophic, an understanding of the anatomy, diagnostic criteria, and appropriate therapy for this putative emergency illness is imperative. This report summarizes a recent 18-month experience with this diagnosis and contrasts this experience with that in the published literature. More than half (14/22) of the patients presented during the first month of life, and all had vomiting, which in most cases was bilious. The barium upper gastrointestinal series was the preferred diagnostic study, being both sensitive (18/19, 95%) and accurate (18/21, 86%). In this series two-thirds of the patients presented with volvulus (15/22, 68%) of whom five had ischemic intestine requiring resection. One of these children died of overwhelming sepsis. A Ladd procedure was the preferred treatment, which as defined by us includes evisceration and inspection of the mesenteric root, counterclockwise derotation of a midgut volvulus, lysis of Ladd's bands with straightening of the duodenum along the right abdominal gutter, inversion-ligation appendectomy, and placement of the cecum into the left lower quadrant. A high index of suspicion in the neonate with vomiting, rapid diagnosis, and appropriate operative therapy results in a predictable favorable outcome for children with intestinal malrotation.
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Affiliation(s)
- A M Torres
- Division of Pediatric Surgery, Children's Hospital Medical Center, Cincinnati, Ohio 45229
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39
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Abstract
We report a father and two sons who each suffered from recurrent acute ileocolic intussusception in childhood, suggesting that there may in some cases be a genetic predisposition to the condition. This might have an anatomical basis.
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Affiliation(s)
- M D Stringer
- Queen Mary's Hospital for Children, Carshalton, England
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40
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Abstract
Intussusception is one of the commonest causes of intestinal obstruction in infants and accounts for about 700 hospital admissions each year in England and Wales. Improved results of treatment have followed recent technological developments, which include ultrasonographic imaging and pneumatic reduction techniques. Most intussusceptions can be reduced successfully without the need for operation but close cooperation between surgeon and radiologist is essential. Mortality and morbidity rates from the condition have progressively declined in recent decades but avoidable deaths still occur.
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Affiliation(s)
- M D Stringer
- Department of Paediatric Surgery, Institute of Child Health, London, UK
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41
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Abstract
During the last decade neonatal surgical results have improved considerably. Except for infants born with serious congenital heart disease, diaphragmatic hernia or exomphalos, postoperative mortality rates for infants with single anomalies have fallen to the region of 10%. This dramatic success story has been marred by a corresponding increase in the number of individuals with several anomalies entering late childhood with severe chronic handicaps. During the remainder of this century much effort will be expended in devising programmes of investigation which will attempt to predict which individuals will have a poor long-term prognosis. Such programmes will necessitate very close liaison between obstetricians, radiologists, neonatologists, local paediatricians, paediatric surgeons, general practitioners and parents. Very urgent surgery is necessary for the best results in infants with gastroschisis, intestinal volvulus and irreducible inguinal hernia, but for most other conditions there have been recent trends away from very urgent surgery to operation during daylight hours within the ensuing 24 h. Surgery within a few hours of presentation is necessary for intussusception and for early acute appendicitis, but perforated appendicitis should be treated by aggressive fluid replacement and intravenous antibiotics and surgery should be contemplated only in the rare cases of continued deterioration.
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42
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Affiliation(s)
- D A Stringer
- Department of Radiology, Hospital For Sick Children, Toronto, Canada
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43
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Powell DM, Othersen HB, Smith CD. Malrotation of the intestines in children: the effect of age on presentation and therapy. J Pediatr Surg 1989; 24:777-80. [PMID: 2769545 DOI: 10.1016/s0022-3468(89)80535-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Because of the devastating consequences of midgut volvulus as a result of malrotation, we reviewed the charts of 70 consecutive children to define the spectrum of presentation. Although 27 patients (39%) had presenting symptoms within the first ten days of life, 35 (50%) were older than 2 months of age. In general, the older children had a longer course of vague, antecedent symptoms such as intermittent, nonbilious vomiting and chronic abdominal pain. Associated congenital anomalies were common, with 32 patients (46%) presenting with 56 anomalies, the most prevalent of which were intestinal atresia, imperforate anus, duodenal web, and cardiac and orthopedic anomalies. Upper gastrointestinal (GI) series revealed the diagnosis in 29 cases (41%), as did contrast enema in 24 (34%). It is important to note that volvulus, intestinal gangrene, and mortality occurred regardless of age or chronicity of symptoms. Fifteen patients (21%) were discovered serendipitously while being evaluated and treated for seemingly unrelated conditions. No morbidity of mortality occurred in those patients who underwent subsequent semielective Ladd's procedure. The majority of morbidity and all seven mortalities occurred in patients with volvulus and intestinal necrosis. This study emphasizes the need for consideration of Ladd's procedure for children of all ages. In addition, due to the broad range of initial symptoms, a high index of suspicion is required in evaluating children with possible malrotation. Because it remains impossible to predict which patients will have catastrophic complications (based on age or type of presentation), we urge that even incidentally discovered patients with intestinal malrotation undergo Ladd's procedure.
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Affiliation(s)
- D M Powell
- Department of Surgery, Medical University of South Carolina, Charleston 29425
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44
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Abstract
Ultrasound was used to demonstrate the abnormal orientation of the mesenteric vessels in six cases of midgut malrotation. Five of these patients were known to have an abnormality of rotation before the ultrasound scan. In one patient malrotation was predicted from the ultrasound scan and confirmed by a barium study and at operation.
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