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Salehi Karlslätt K, Husberg B, Ullberg U, Nordenskjöld A, Wester T. Intestinal Malrotation in Children: Clinical Presentation and Outcomes. Eur J Pediatr Surg 2024; 34:228-235. [PMID: 36882104 DOI: 10.1055/s-0043-1764239] [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] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Intestinal malrotation (IM) is characterized by abnormal intestinal rotation and fixation predisposing to a risk of midgut volvulus. The aim of this study was to describe the clinical presentation and outcome of IM from birth through childhood. MATERIALS AND METHODS This was a retrospective study of children with IM managed at a single center between 1983 and 2016. Data were retrieved from medical records and analyzed. RESULTS Three hundred nineteen patients were eligible for the study. Using strict inclusion and exclusion criteria, 138 children were included. Vomiting was the most common symptom up to 5 years of age. At 6 to 15 years of age, abdominal pain was the predominant symptom. One hundred twenty-five patients underwent a Ladd's procedure and of 124 patients with available data, 20% had a postoperative complication (Clavien-Dindo IIIb-V) within 30 days. The odds ratio to develop postoperative complications was significantly increased in extremely preterm patients (p = 0.001) and in patients with severely affected intestinal circulation (p = 0.006). Two patients had intestinal failure due to midgut loss after midgut volvulus, one of whom needed intestinal transplantation. Four patients, all extremely preterm, died related to the surgical procedure. In addition, seven patients died of reasons not related to IM. Fourteen patients (11%) had adhesive bowel obstruction and one patient had recurrent midgut volvulus requiring surgical treatment. CONCLUSIONS IM presents with different symptoms through childhood depending on age. Postoperative complications are common after Ladd's procedure, particularly among extremely preterm infants and patients with severely affected circulation caused by midgut volvulus.
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Affiliation(s)
- Karin Salehi Karlslätt
- Department of Women's and Children's Health, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Husberg
- Department of General Surgery, Ersta Hospital, Stockholm, Sweden
| | - Ulla Ullberg
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Agenta Nordenskjöld
- Department of Women's and Children's Health, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Wester
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Gibson A, Silva H, Bajaj M, McBride C, Choo K, Morrison S. No safe time window in malrotation and volvulus: A consecutive cohort study. J Paediatr Child Health 2024; 60:206-211. [PMID: 38715374 DOI: 10.1111/jpc.16555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/29/2023] [Accepted: 04/17/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Malrotation and volvulus classically present with bilious vomiting. It is more common earlier in life, but there are other causes of bile-stained vomiting. This leads some clinicians to 'watch and wait'. In the presence of a volvulus, this is potentially a fatal decision. It is not clear from the literature if there is a safe time window in which children can be observed in the hope of avoiding transfers or radiological investigations. AIM To determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care. METHODS Multicentre, retrospective review of all children with malrotation ± volvulus at two tertiary children's hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re-operations and death. RESULTS There were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile-stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post-operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re-operation. CONCLUSION Malrotation remains a time-critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for 'watch and wait' for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.
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Affiliation(s)
- Aimee Gibson
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Hobia Silva
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Mohit Bajaj
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Craig McBride
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kelvin Choo
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Shannon Morrison
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
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Patel D, Banks D, Hira B, Ford M, Ambartsumyan L, Rodriguez L. Persistent and newly developed gastrointestinal symptoms after surgery for intestinal malrotation in children: Dysmotility or disorders of gut and brain interaction? J Pediatr Gastroenterol Nutr 2024; 78:827-835. [PMID: 38451033 DOI: 10.1002/jpn3.12178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Surgery for intestinal malrotation (IM) aims to correct the defect and improve symptoms; however, many have persistent gastrointestinal (GI) symptoms postoperatively. We evaluated the incidence, clinical presentation, and long-term outcomes of children with surgically repaired IM and its possible association with disorders of gut and brain interaction (DGBI). METHODS Multicenter retrospective study was conducted in patients from 0 to 21 years old, who had surgery for IM from 2000 to 2021 across three pediatric tertiary care centers. Data analyzed included demographics, time to diagnosis, idiopathic diagnosis, incidental diagnosis, postoperative follow-up, surgical time, and the need for surgery including bowel detorsion. Outcome variables were the presence of postoperative GI symptoms and DGBIs, and overall resolution of symptoms. We also evaluated the potential association of demographics and other included variables with our outcome variables. RESULTS Ninety-two patients with surgically corrected IM were included, 54% were male, and median age of diagnosis and surgical correction was 4.9 and 7.8 months, respectively. Median follow-up after surgery was 64 months. A total of 77% had postoperative GI symptoms, and notably, 78% of patients without symptoms before surgery (incidental diagnosis) developed GI symptoms postoperatively and 27% of patients met Rome IV criteria for a one or more DGBI. No factors were associated to the presence of postoperative symptoms or DGBIs in multivariate analysis. Female gender was the only factor associated with lack of resolution of symptoms at follow-up. CONCLUSION Pediatric IM is commonly associated with postoperative GI symptoms and DGBI well beyond surgery. An increased awareness about the prevalence of DGBI in these patients may help reach a prompt and accurate diagnosis, and improve their quality of life.
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Affiliation(s)
- Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Darnna Banks
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, New Haven Children's Hospital, Yale University, New Haven, Connecticut, USA
| | - Bindi Hira
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Madeline Ford
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Leonel Rodriguez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, New Haven Children's Hospital, Yale University, New Haven, Connecticut, USA
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Devkota S, Luitel P, Paudel S, Neupane N, Dev S, Kansakar PBS. Incidentally discovered intestinal malrotation during evaluation for blunt abdominal trauma: A case report. Int J Surg Case Rep 2024; 116:109430. [PMID: 38428056 PMCID: PMC10944091 DOI: 10.1016/j.ijscr.2024.109430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intestinal malrotation is a congenital abnormality predominantly diagnosed in children, with only a few cases reported in adults. Patients may be incidentally identified during unrelated surgical procedures or postmortem examinations. It is crucial to promptly recognize this condition to prevent severe complications such as bowel ischemia and potential fatality. CASE PRESENTATION A 40-year-old male presented to the Emergency Department after a child jumped on his abdomen with complaints of acute left upper quadrant abdominal pain progressing to be generalized. Examination showed pallor, abdominal tenderness without guarding or rigidity, and intact bowel sounds. Preoperative diagnostic tools revealed intestinal malrotation confirmed during the laparotomy, prompting the performance of Ladd's procedure to address the malrotation. CLINICAL DISCUSSION Disruption in the normal embryological development of bowel is the cause of intestinal malrotation. The role of additional surgery especially in patients with asymptomatic disease related to malrotation is debated. CONCLUSION Intestinal malrotation is rare in adults and often found incidentally during evaluation for unrelated medical conditions. Timely identification and surgical intervention usually result in positive outcomes. Our case underscores the incidental discovery of malrotation during the evaluation of blunt abdominal trauma, treated with Ladd's procedure. This is particularly significant due to geographical constraints associated with the patient's rural origin, as untreated malrotation could lead to complications in future occurrences.
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Affiliation(s)
- Shishir Devkota
- Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Prajjwol Luitel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Sujan Paudel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Nischal Neupane
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Santosh Dev
- Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Prasan Bir Singh Kansakar
- Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
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Girolamo M, Emanuela G, Yu WMC, Anna M, Marta P, Grazia CM, Gandullia P, Arrigo S, Stefano A, Beatrice DM. Diagnostic accuracy of upper gastrointestinal series in children with suspected intestinal malrotation. Updates Surg 2024; 76:201-208. [PMID: 37326933 PMCID: PMC10806024 DOI: 10.1007/s13304-023-01559-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
Intestinal malrotation (IM) results from an altered or incomplete rotation of the fetal midgut around the superior mesenteric artery axis. The abnormal anatomy of IM is associated with risk of acute midgut volvulus which can lead to catastrophic clinical consequences. The upper gastro-intestinal series (UGI) is addressed as the gold standard diagnosis procedure, but a variable failure degree has been described in literature. The aim of the study was to analyze the UGI exam and describe which features are the most reproducible and reliable in diagnosing IM. Medical records of patients surgically treated for suspected IM between 2007 and 2020 at a single pediatric tertiary care center were retrospectively reviewed. UGI inter-observer agreement and diagnostic accuracy were statistically calculated. Images obtained with antero-posterior (AP) projections were the most significant in terms of IM diagnosis. Duodenal-Jejunal Junction (DJJ) abnormal position resulted to be the most reliable parameter (Se = 0.88; Sp = 0.54) as well as the most readable, with an inter-reader agreement of 83% (k = 0.70, CI 0.49-0.90). The First Jejunal Loops (FJL), caecum altered position and duodenal dilatation could be considered additional data. Lateral projections demonstrated an overall low sensitivity (Se = 0.80) and specificity (Sp = 0.33) with a PPV of 0.85 and a NPV of 0.25. UGI on the sole AP projections ensures a good diagnostic accuracy. The position of the third portion of the duodenum on lateral views showed an overall low reliability, therefore it was not helpful but rather deceiving in diagnosing IM.
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Affiliation(s)
- Mattioli Girolamo
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | | | - Wong Michela Cing Yu
- Pediatric Surgery Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
- , Via Gerolamo Gaslini, 5, 16148, Genoa, Italy.
| | - Marzoli Anna
- Radiology Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Pongiglione Marta
- Radiology Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Calevo Maria Grazia
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Avanzini Stefano
- Pediatric Surgery Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
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Emmerson MK, Dawson M. 'Grumbling' Midgut Volvulus in an Older Paediatric Patient With Congenital Solitary Kidney: A Case Report. Cureus 2023; 15:e49202. [PMID: 38130574 PMCID: PMC10735324 DOI: 10.7759/cureus.49202] [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: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
Midgut volvulus is a life-threatening condition, with the majority of cases presenting before the first year of life. Congenital gastrointestinal abnormalities can be associated with midgut volvulus; however, similar associations have not been described with congenital renal abnormalities. Congenital solitary kidney (CSK) means that a child is born with only one functional kidney. Here, we describe a case of a five-year-old child with CSK who atypically presents with midgut volvulus. The case highlights how midgut volvulus may present with chronic symptoms in those over the age of one and the importance of upper GI contrast studies for diagnosis of midgut volvulus in this population and suggests CSK along with other causes of solitary kidney as possible risk factors for volvulus.
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Affiliation(s)
- Matthew K Emmerson
- Paediatric Emergency Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - Moya Dawson
- Paediatric Emergency Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
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Yan J, Xie C, Chen Y. Surgical Treatment of Mesenteric Lymphatic Malformations in Children: An Observational Cohort study. J Pediatr Surg 2023; 58:1762-1769. [PMID: 36931944 DOI: 10.1016/j.jpedsurg.2023.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Few studies have analyzed the cyst characteristics and complications of mesenteric lymphatic malformations (ML). This study aimed to compare ML's cyst characteristics and preoperative complications at different locations and suggest a modified ML classification for patients requiring surgery. METHODS In total, 157 ML patients underwent surgery at Beijing Children's Hospital between January 2010 and December 2021. The cyst characteristics and preoperative complications were reviewed. The surgical methods for ML were analyzed according to the modified ML classification (Type I, n = 87, involving the intestinal wall; Type II, n = 45, located in the mesenteric boundaries; Type III, n = 16, involving the root of the mesentery; Type IV, n = 7, multicentric ML; Type V, n = 2, involving the upper rectum). RESULTS Overall, 111 (70.7%) ML were located at the intestinal mesentery and 44 (28.0%) at the mesocolon. Type I and type II ML mainly involved intestinal mesentery (64.9%) and mesocolon (56.8%), respectively (P < 0.001). Microcystic-type ML and ML with chylous fluid were only located in the intestinal mesentery. Intestinal volvulus was only found in patients with ML in the intestinal mesentery (P < 0.001), whereas ML in the mesocolon were more prone to hemorrhage (P = 0.002) and infection (P = 0.005). ML in the jejunal mesentery was an independent risk factor for intestinal volvulus (OR = 3.5, 95% CI 1.5-8.3, P = 0.003). The surgical methods significantly differed between Type I and type II ML (P < 0.001). CONCLUSIONS ML at different locations have different characteristics. For patients requiring surgery, the new ML classification can be used to select an appropriate surgical method. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chuanping Xie
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Patel D, Halverson C, Jayaraman M, Ambartsumyan L, Rodriguez L. Gastrointestinal Symptoms After Surgery for Intestinal Malrotation. J Pediatr Gastroenterol Nutr 2023; 77:316-318. [PMID: 37256844 DOI: 10.1097/mpg.0000000000003840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Dhiren Patel
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St Louis, MO
| | | | | | - Lusine Ambartsumyan
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
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Nagano A, Sugita K, Harumatsu T, Nishida N, Kedoin C, Murakami M, Yano K, Onishi S, Matsukubo M, Kawano T, Muto M, Torikai M, Kaji T, Ieiri S. Predictive factors of bowel resection for midgut volvulus based on an analysis of bi-center experiences in southern Japan. Pediatr Surg Int 2023; 39:113. [PMID: 36764971 DOI: 10.1007/s00383-023-05406-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Midgut volvulus is an urgent disease often occurring in neonates. This study clarified the clinical features of midgut volvulus and evaluated predictors to avoid bowel resection. METHODS This bi-center retrospective study enrolled 48 patients who underwent surgery for intestinal malrotation between 2010 and 2022. Patients' background characteristics and preoperative imaging findings were reviewed. RESULTS Midgut volvulus was recognized in 32 patients (66.7%), and 6 (12.5%) underwent bowel resection. Based on a receiver operating curve analysis of bowel resection, the cut-off value of the body weight at birth and at operation were 1984 g [area under the curve (AUC) 0.75, 95% confidence interval (CI) 0.52-0.99] and 2418 g (AUC 0.70, 95% CI 0.46-0.94), respectively. The cut-off value of intestinal torsion was 540° (AUC 0.76, 95% CI 0.57-0.95), and that of the time from the onset to the diagnosis was 12 h (AUC 0.85, 95% CI 0.72-0.98). For midgut volvulus with an intestinal torsion > 540°, the most sensitive preoperative imaging test was ultrasonography (75%) Patients with bloody stool tended to undergo bowel resection. CONCLUSIONS Patients with a low body weight and bloody stool should be confirmed to have whirlpool sign by ultrasonography and scheduled for surgery as soon as possible.
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Affiliation(s)
- Ayaka Nagano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Nanako Nishida
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Keisuke Yano
- Department of Neonatal Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Makoto Matsukubo
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
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Skidmore BD, Larson MC, Desoky SM, Gilbertson-Dahdal D. Midgut malrotation and volvulus presenting outside of the newborn period. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Yassin S, Stoica I, Muntean A, Byrne A, Sweeney B. Chronic midgut volvulus - A challenging diagnosis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yang B, Huang D, Zhou L, Zhong W, He Q, Wang Z, Fang Q, Wang H. The value of saline-aided ultrasound in diagnosing congenital duodenal obstruction. Pediatr Surg Int 2020; 36:1197-1203. [PMID: 32715324 DOI: 10.1007/s00383-020-04723-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study is to assess the value of saline-aided ultrasound (US) in diagnosing congenital duodenal obstruction (CDO). METHODS The neonates with CDO were enrolled in this study, including the neonates confirmed with annular pancreas (AP) by operation, the neonates confirmed with duodenal atresia, the neonates confirmed with duodenum web, and the neonates confirmed with malrotation. Pertinent data were recorded, including the US features, intraoperative findings, and surgical procedures. The methodology of this study is a diagnostic test study which means the US feature is the test and the intraoperative finding is the gold standard. RESULTS A total of 95 neonates were enrolled, including 33 neonates with AP, 6 neonates with duodenal atresia, 29 neonates with duodenum web, and 27 neonates with malrotation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the hyperechogenic band for the detection of AP were 78.8% (26/33), 90.3% (56/62), 81.2% (26/32), 88.8% (56/63), and 86.3% (82/95), respectively. The sensitivity, specificity, NPV, and accuracy for the detection of duodenal atresia were 0% (0/6), 100% (89/89), 93.6% (89/95), and 93.6% (89/95), respectively. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of duodenum web were 100% (29/29), 100% (66/66), 100% (29/29), 100% (66/66), and 100% (95/95), respectively. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of malrotation were 100% (27/27), 100% (68/68), 100% (27/27), 100% (68/68), and 100% (95/95), respectively. CONCLUSION Saline-aided US is a feasible tool to diagnose CDO.
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Affiliation(s)
- Boyang Yang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China
| | - Danping Huang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Wei Zhong
- Department of Neonatal Surgery and Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qiuming He
- Department of Neonatal Surgery and Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Zhe Wang
- Department of Neonatal Surgery and Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qian Fang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China
| | - Hongying Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China.
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Lamichhane A, Sharma R, Rajkarnikar R, Awale R, Shrestha P, Oli NC. A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report. ACTA ACUST UNITED AC 2020; 58:600-603. [PMID: 32968296 PMCID: PMC7580366 DOI: 10.31729/jnma.5134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd's band was diagnosed based on clinical acumen, high-resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd's procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd's band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.
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Affiliation(s)
- Anita Lamichhane
- Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal
| | - Rupesh Sharma
- Department of Radiology, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal
| | - Ramana Rajkarnikar
- Department of Pediatric Surgery, Kanti Children's Hospital, Kathmandu, Nepal
| | - Rubee Awale
- Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal
| | - Prapti Shrestha
- Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal
| | - Nava Chandra Oli
- Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal
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14
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Nwokoro CC, Emmanuel EA, Olatunji AA, Salami BA, Amosu LO, Ogundele IO. Malrotation of the midgut associated with horseshoe kidney presenting as gastric outlet obstruction in a 15-year-old boy. Afr J Paediatr Surg 2020; 17:122-126. [PMID: 33342849 PMCID: PMC8051629 DOI: 10.4103/ajps.ajps_92_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Malrotation occurs in approximately 1 in 500 live births. However, the true incidence of malrotation is unknown since many asymptomatic patients fail to present. Approximately 90% of patients with malrotation are diagnosed within the 1st year of life. Eighty per cent of them are diagnosed within the 1st month of life. Nevertheless, there are recent reports of manifestations later in life both as emergency conditions and more chronic gastrointestinal symptoms. The relationship between malrotation and horseshoe kidney has not been fully understood, but few case reports have highlighted their occurrence in the same patient. The mode of presentation of this case and its association with a horseshoe kidney is the reason for this report. This was a case of malrotation associated with horseshoe kidney. He had exploratory laparotomy and Ladd's procedure. Malrotation is associated with horseshoe kidney which presented as gastric outlet obstruction. He responded well to treatment after Ladd's procedure.
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Affiliation(s)
- Chigbundu Collins Nwokoro
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - E A Emmanuel
- Department of Anaesthesia and Intensive Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - A A Olatunji
- Department of Radiology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - B A Salami
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - L O Amosu
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - I O Ogundele
- Department of Surgery, Paedaitric Surgery Unit, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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15
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Colvin D, Bourke T, Thompson A, Dick AC. Should children with non-bilious vomiting and malrotation undergo a Ladd's procedure or be managed conservatively? Arch Dis Child 2019; 104:1116-1118. [PMID: 31391154 DOI: 10.1136/archdischild-2019-317672] [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: 06/03/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/03/2022]
Affiliation(s)
- David Colvin
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Thomas Bourke
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK.,Department of Medical Education, Queen's University of Belfast: Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - Andrew Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Alistair C Dick
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
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16
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Nishio Y, Kawano Y, Hara S. Nutcracker syndrome complicated with intestinal malrotation. BMJ Case Rep 2019; 12:12/10/e231230. [PMID: 31604719 DOI: 10.1136/bcr-2019-231230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Nutcracker syndrome (NCS) is a pathological condition in which the left renal vein (LRV) is compressed between the superior mesenteric artery (SMA) and aorta. NCS can predispose patients to the onset of chronic kidney disease because of persistent increase in LRV pressure. Although NCS in children is often idiopathic, it can also be caused by underlying pathologies such as retroperitoneal tumours. To the best of our knowledge, there have been no reports regarding paediatric cases of NCS complicated with intestinal malrotation. Here, we report the case of a 12-year-old girl with intestinal malrotation complicated with NCS whose haematuria resolved after surgical intervention for intestinal malrotation. The present case findings indicate that intestinal malrotation with concomitant weight loss is a potential underlying aetiology in NCS. Thus, when NCS is especially diagnosed with gastrointestinal symptoms, intestinal malrotation should be considered as an underlying aetiology.
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Affiliation(s)
- Yosuke Nishio
- Pediatrics, TOYOTA Memorial Hospital, Toyota, Aichi, Japan
| | | | - Shinya Hara
- Pediatrics, TOYOTA Memorial Hospital, Toyota, Aichi, Japan
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17
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Dekonenko C, Sujka JA, Weaver K, Sharp SW, Gonzalez K, St Peter SD. The identification and treatment of intestinal malrotation in older children. Pediatr Surg Int 2019; 35:665-671. [PMID: 30810798 DOI: 10.1007/s00383-019-04454-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Intestinal malrotation is often diagnosed in infancy. The true incidence of malrotation outside of this age is unknown. These patients can present atypically or be asymptomatic and diagnosed incidentally. We evaluate the incidence, clinical presentation, ideal imaging, and intra-operative findings of patients with malrotation over 1 year of age. METHODS Retrospective review was conducted in patients older than 1 year, treated for malrotation at a single pediatric tertiary care center from 2000 to 2015. Data analyzed included demographics, presentation, imaging, intraoperative findings, and follow-up. Patients predisposed to malrotation were excluded. RESULTS 246 patients were diagnosed with malrotation, of which 77 patients were older than 1 year of age. The most common presenting symptoms were vomiting (68%) and abdominal pain (57%). The most common method of diagnosis was UGI (61%). In 88%, the UGI revealed malrotation. 73 of 75 were confirmed to have malrotation at surgery. Intra-operatively, 60% were found to have a malrotated intestinal orientation and 33% with a non-rotated orientation. Obstruction was present in 22% with 12% having volvulus. Of those with follow-up, 58% reported alleviation of symptoms. CONCLUSION Despite age malrotation should be on the differential given a variable clinical presentation. UGI should be conducted to allow for prompt diagnosis and surgical intervention.
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Affiliation(s)
- Charlene Dekonenko
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Joseph A Sujka
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Katrina Weaver
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Susan W Sharp
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Katherine Gonzalez
- Department of Surgery, John Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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18
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Gentile A, Bolcato M, Militerno G, Rademacher G, Desrochers A, Grandis A. Heterotopy ("Error loci") of the spiral loop of the ascending colon in cattle. PLoS One 2019; 14:e0215402. [PMID: 30978255 PMCID: PMC6461275 DOI: 10.1371/journal.pone.0215402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/01/2019] [Indexed: 12/03/2022] Open
Abstract
The term heterotopy of the spiral colon encompasses a dysmorphological condition in which the spiral loops of the ascending colon (SLACs) do not form an orderly spiraling mass adjacent to the left side of the mesojejunum. As a consequence, the spiral loops are spread over a larger surface, making them more or less movable. It has been hypothesized that the abnormal position of the spiral loops of the ascending colon might constitute a predisposing factor for an intestinal obstruction or an ileus condition. The objective of the present study was to evaluate the anatomy of the spiral loops of the ascending colon in a population of healthy calves and to determine the prevalence of dysmorphism. The investigation was carried out on 1113 slaughtered veal calves. In 472 out of the 1113 calves, the spiral loops showed conformational aspects different from what has so far been described as normal in reference textbooks. In 91 calves the condition was definitely considered a pathological deviation from normality: in fact, the spiral colon had lost its typical spiral shape with random spacing between the loops, and it was nearly or completely detached from the mesojejunum. The lack of a broad attachment of the spiral loops of the ascending colon to the mesentery could provoke an alteration of the intestinal centre of gravity, enhancing the already asymmetrical distribution of weight between the jejunum and the descending colon.
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Affiliation(s)
- Arcangelo Gentile
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
- * E-mail:
| | - Marilena Bolcato
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Gianfranco Militerno
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Günter Rademacher
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - André Desrochers
- Department of Clinical Science, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Canada
| | - Annamaria Grandis
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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19
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Anand U, Kumar R, Priyadarshi RN, Kumar B, Kumar S, Singh VP. Comparative study of intestinal malrotation in infant, children, and adult in a tertiary care center in India. Indian J Gastroenterol 2018; 37:545-549. [PMID: 30535747 DOI: 10.1007/s12664-018-0914-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intestinal malrotation (IM) is an uncommon condition and has varied presentation in different age groups. The study was aimed to evaluate differences in the clinical presentation, diagnosis, treatment, and outcome of IM in infants, children, and adults. METHODS Data were collected from records of 79 patients with IM. Based on the age of presentation, these patients were categorized into three age groups: infants (up to 1 year), children (1-18 years), and adults (> 18 years). Follow up data were analyzed during 8 to 16 year after corrective surgery. RESULTS The overall age of presentation ranged from 8 days to 60 years. Twenty-eight, 29, and 22 patients belonged to the infant, children, and adult groups, respectively. The classical presentation of IM (bilious vomiting) was significantly higher in the infant compared to the children and adult groups (100% vs. 62% vs. 9.8%; p < 0.001). All infants presented with acute symptoms. However, children and adults had subacute or chronic presentations, respectively. The incidence of volvulus was significantly higher in the infant group than other two groups, (100% vs. 41% vs. 10%; p < 0.001). Doppler ultrasound was highly accurate in infants (100%), whereas contrast-enhanced computed tomography (CECT) abdomen was found to be most useful in adults. Postoperative complications were more common in adults. CONCLUSION Intestinal malrotation can present in patients of any age group. An increased awareness about the atypical presentations of this condition among adults may reduce the time to accurate diagnosis of this disease.
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Affiliation(s)
- Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India.
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India
| | - Rajeev N Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India
| | - Bindey Kumar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India
| | - Sanjay Kumar
- Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Bailey Road, Raja Bazar, Sheikhpura, Patna, 800 014, India
| | - Vijay Prakash Singh
- Department of Gastroenterology, Patna Medical College and Hospital, Ashok Rajpath Road, Patna University Campus, Patna, 800 001, India
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20
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Ryerson LM, Pharis S, Pockett C, Soni R, Fruitman D, Guleserian KJ, Nater M, Raynor SC, Mackie AS, Dicken B. Heterotaxy Syndrome and Intestinal Rotation Abnormalities. Pediatrics 2018; 142:peds.2017-4267. [PMID: 30049892 DOI: 10.1542/peds.2017-4267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Infants with heterotaxy syndrome (HS) have abnormal lateralization of organs along the right-left body axis. Intestinal rotation abnormalities (IRAs) are a potential source of morbidity and mortality. For this study, our objective was to prospectively observe a cohort of infants with HS and determine the incidence and natural history of IRA. METHODS Infants ≤6 months of age with HS were enrolled in this prospective observational study. Exclusion criteria were other congenital abnormalities that necessitated abdominal surgery. HS was defined as any arrangement of organs that was not situs solitus or situs inversus along with associated congenital heart disease. The investigation for IRA was at the discretion of each participating center. RESULTS Infants were recruited from January 2012 to December 2016. Thirty-eight infants from 7 institutions were included; 22 infants had right isomerism and 16 infants had left isomerism. Twenty-nine infants (76%) were evaluated for IRAs; 21 of 29 evaluations (72%) were abnormal. Eight infants were investigated because of symptoms, and 21 infants were evaluated routinely. The median age at symptom presentation was 46 days (range: 5-171 days). Seven infants had a Ladd procedure; 4 were prophylactic, with 3 as part of a combined procedure, and 3 were emergent. No child suffered acute midgut volvulus over a median follow-up of 1.6 years (range: 0.06-4.93 years). CONCLUSIONS IRAs are common in infants with HS. Infants with symptoms presented by 6 months of age. There was no failure of expectant management resulting in midgut volvulus during a median follow-up of 1.6 years.
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Affiliation(s)
- Lindsay M Ryerson
- Pediatric Cardiac Intensive Care Unit, Stollery Children's Hospital, Edmonton, Alberta, Canada;
| | - Scott Pharis
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Charissa Pockett
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Reeni Soni
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deborah Fruitman
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Melissa Nater
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Stephen C Raynor
- Division of Pediatric Surgery, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska; and
| | | | - Bryan Dicken
- Surgery, University of Alberta, Edmonton, Alberta, Canada
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21
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Enyuma COA, Adam A, Aigbodion SJ, McDowall J, Gerber L, Buchanan S, Laher AE. Role of the ultrasonographic ‘whirlpool sign’ in intestinal volvulus: a systematic review and meta-analysis. ANZ J Surg 2018; 88:1108-1116. [DOI: 10.1111/ans.14495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/25/2018] [Accepted: 02/27/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Callistus O. A. Enyuma
- Department of Emergency Medicine, Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
- Department of Paediatrics, Faculty of Medicine; University of Calabar/Teaching Hospital; Calabar Nigeria
| | - Ahmed Adam
- Division of Urology, Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - Sunday J. Aigbodion
- Department of Emergency Medicine, Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - Jared McDowall
- Department of Emergency Medicine, Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - Louis Gerber
- Department of Emergency Medicine, Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - Sean Buchanan
- Department of Emergency Medicine, Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
| | - Abdullah E. Laher
- Department of Emergency Medicine, Faculty of Health Sciences; University of the Witwatersrand; Johannesburg South Africa
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22
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Zhang W, Sun H, Luo F. The efficiency of sonography in diagnosing volvulus in neonates with suspected intestinal malrotation. Medicine (Baltimore) 2017; 96:e8287. [PMID: 29049228 PMCID: PMC5662394 DOI: 10.1097/md.0000000000008287] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study is to prospectively evaluate the efficiency of sonography for volvulus diagnosis in neonates with clinically suspected intestinal malrotation.A total of 83 patients with suspected intestinal malrotation who underwent detailed abdominal sonography and upper gastrointestinal contrast study were included. Malrotation was characterized by inversion of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in sonographic examination. The "whirlpool sign" of Color Doppler Sonography was recognized as a characteristic for malrotation with volvulus. The degrees of rotation of the SMV winding around SMA were also detected by sonography. Surgery was performed in patients with sonography diagnosed malrotation.A total of 39 patients were sonographically diagnosed as malrotation which was subsequently confirmed by surgery. The sensitivity and positive predictive value of the sonographic diagnosis were both 100% (39/39). The sensitivity, specificity and accuracy of "whirlpool sign" for the detection of midgut volvulus were 95.2% (20/21), 88.9% (16/18), and 92.3% (36/39), respectively. Greater degrees of rotation (equal or greater than 720°) showed higher risk (odds ratio, 5.0; P < .01) for intestinal necrosis occurrence.Sonography is more accurate in diagnosing suspected malrotation than upper gastrointestinal contrast study. Specific sonographic "whirlpool sign" related to volvulus may be used as a potential indicator for intestinal necrosis. In addition, sonography can exclude malrotation and may help the diagnosis of other diseases, such as annular pancreas and duodenal atresia.
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23
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Birajdar S, Rao SC, Bettenay F. Role of upper gastrointestinal contrast studies for suspected malrotation in neonatal population. J Paediatr Child Health 2017; 53:644-649. [PMID: 28425590 DOI: 10.1111/jpc.13515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/19/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
AIM Upper gastrointestinal (UGI) contrast study is the preferred radiological investigation to diagnose malrotation of intestine. We aimed to review the role of UGI contrast in neonates (term and preterm) who were clinically suspected to have malrotation. METHODS The study included a retrospective review of medical charts and radiology reports. RESULTS A total of 164 newborn infants underwent UGI contrast study to rule out malrotation during the study period (2006-2015). Median gestational age at the time of presentation was 38 weeks (interquartile range: 35.5-39.6 weeks). Median age for clinical presentation was day 2 of life (interquartile range: 2-5 days). Out of the 164 contrast studies, 112 were normal, whereas 52 were reported to have malrotation. Of those 52 infants, 47 were confirmed to have malrotation on surgery (positive predictive value: 90). Of the 112 infants with normal UGI contrasts, nine infants underwent laparotomy for ongoing clinical symptoms out of which four infants were diagnosed to have malrotation on laparotomy. There were 22 infants born at gestational age <32 weeks, who underwent UGI contrast studies to rule out malrotation. Their clinical symptoms were similar to necrotising enterocolitis. Of 22 preterm contrast studies, six were reported to have malrotation; of these, five had surgically confirmed malrotation. No complications related to the contrast study were noted in both term and preterm infants. CONCLUSION Current study reaffirms the role of UGI contrast study as the investigation of choice for diagnosis of malrotation, in both term and preterm infants. UGI contrast is safe and well tolerated even in preterm infants.
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Affiliation(s)
- Suresh Birajdar
- Department of Neonatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Shripada C Rao
- Department of Neonatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Fiona Bettenay
- Department of Diagnostic Imaging, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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24
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Karaman İ, Karaman A, Çınar HG, Ertürk A, Erdoğan D, Özgüner İF. Is color Doppler a reliable method for the diagnosis of malrotation? J Med Ultrason (2001) 2017; 45:59-64. [DOI: 10.1007/s10396-017-0794-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022]
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25
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Kotobi H, Tan V, Lefèvre J, Duramé F, Audry G, Parc Y. Total midgut volvulus in adults with intestinal malrotation. Report of eleven patients. J Visc Surg 2016; 154:175-183. [PMID: 27888039 DOI: 10.1016/j.jviscsurg.2016.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Total small-intestinal volvulus with malrotation (TSIVM) classically presents in the neonatal period; it occurs much less frequently in the adult and is often misdiagnosed. Prognosis is directly related to the degree and duration of intestinal ischemia. Our goal is to describe our experience with TSIVM in the adult, to identify any specific findings and to discuss its management. METHOD Eleven patients who had undergone surgery for TSIVM at three centers between 1992 and 2012 were included. Surgery was performed as an emergency for five patients and surgery was elective for six. RESULTS Mean follow-up was 63 months (range: 12-270). Six patients had had previous abdominal surgery. In nine cases, the diagnosis of TSIVM was made preoperatively, mainly by CT scan in eight cases. Seven patients had associated congenital failure of retroperitoneal fixation of the right colon and all of these underwent a Ladd procedure. The mortality rate was zero. Of the five patients who underwent emergency surgery, three required intestinal resections, one of whom developed a short bowel syndrome. The six patients who underwent surgery electively had no surgical complications. CONCLUSION TSIVM is a very unusual finding in adult patients. The diagnosis can be made by CT scan with IV and oral contrast, but it often comes to light only at the time of surgery, even though the patients have often had recurrent episodes of abdominal symptomatology that dated back to childhood. The Ladd procedure, consisting of division of Ladd's bands, widening of the mesentery, and incidental appendectomy, remains the standard surgical repair. Digestive surgeons who care for adults should be familiar with this procedure, and it should be performed, as often as possible, with the assistance of a pediatric surgeon.
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Affiliation(s)
- H Kotobi
- Service de chirurgie viscérale pédiatrique et néonatale, hôpital d'Enfants Armand-Trousseau, AP-HP, université Pierre et Marie Curie, Paris VI, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Service de chirurgie générale et digestive B, hôpital Bichat, AP-HP, 75018 Paris, France.
| | - V Tan
- Service de chirurgie digestive, hôpital Saint-Antoine, AP-HP, université Pierre et Marie Curie, Paris VI, 75012 Paris, France
| | - J Lefèvre
- Service de chirurgie digestive, hôpital Saint-Antoine, AP-HP, université Pierre et Marie Curie, Paris VI, 75012 Paris, France
| | - F Duramé
- Service de chirurgie générale et digestive B, hôpital Bichat, AP-HP, 75018 Paris, France
| | - G Audry
- Service de chirurgie viscérale pédiatrique et néonatale, hôpital d'Enfants Armand-Trousseau, AP-HP, université Pierre et Marie Curie, Paris VI, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Y Parc
- Service de chirurgie digestive, hôpital Saint-Antoine, AP-HP, université Pierre et Marie Curie, Paris VI, 75012 Paris, France
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26
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Ezer SS, Oguzkurt P, Temiz A, Ince E, Gezer HO, Demir S, Hicsonmez A. Intestinal malrotation needs immediate consideration and investigation. Pediatr Int 2016; 58:1200-1204. [PMID: 27353636 DOI: 10.1111/ped.13075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 03/06/2016] [Accepted: 04/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate clinical presentation, diagnostic studies, and volvulus rate and to describe the unusual clinical clues of intestinal malrotation. METHODS A retrospective descriptive review was carried out of all patients diagnosed with intestinal malrotation between 2002 and 2014. Patients were divided into two groups: infants (≤1 year, n = 16; group 1); and children (>1 year, n = 12; group 2). Patient demographics, clinical history, symptoms, physical examination, diagnostic work-up, operative findings and early outcome were evaluated. RESULTS Bilious vomiting was the cardinal complaint in both groups. Unusual symptoms such as respiratory insufficiency, dehydration, afebrile convulsion, and lethargy were prominent symptoms in six patients in group 1, whereas history of frequent hospitalization due to recurrent abdominal pain and feeding intolerance were prominent in six patients in group 2. Midgut volvulus was identified in 15 patients, four of whom were in group 2. Standard Ladd's procedure was done in addition to correction of volvulus. CONCLUSION Malrotation with or without midgut volvulus is not a rare condition and should be kept in mind for any age group. Specific signs of diagnosis are not easily identified. In the case of unusual clinical presentation, diagnosis may be delayed and can result in catastrophic consequences if intestinal perfusion occurs. Although midgut volvulus is seen most frequently in infants, risk and complication rate are high beyond 1 year of age as well, and can manifest as failure to thrive, food intolerance, and abdominal pain needing recurrent hospitalization. Diagnostic suspicion and interdisciplinary coordination are essential for timely diagnosis and surgical treatment.
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Affiliation(s)
- Semire Serin Ezer
- Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Pelin Oguzkurt
- Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Abdulkerim Temiz
- Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Emine Ince
- Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Hasan Ozkan Gezer
- Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Senay Demir
- Department of Radiology, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Akgun Hicsonmez
- Department of Pediatric Surgery, Başkent University, Faculty of Medicine, Ankara, Turkey
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Arthur F, Carachi R. Malrotation in infancy and childhood. Scott Med J 2016; 61:69-73. [PMID: 27578853 DOI: 10.1177/0036933016649870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The cardinal features of bilious vomiting and abdominal distension assist in the diagnosis of malrotation and volvulus, an often fatal condition in the neonate. When these symptoms are absent, however, diagnosis becomes trickier. In the older child, these classic symptoms are less likely to occur, or occur at a later stage, meaning these children suffer from a delay in diagnosis and consequently do poorer. There is a need, therefore, to identify the common presenting features in these older children in order to facilitate earlier diagnosis and improve outcomes. METHODS We reviewed the current literature (Appendix 1) and then undertook a retrospective study in our own department to explore the presenting complaint, time to diagnosis, intraoperative findings and outcome of all children over the age of 28 days who underwent a Ladd's procedure for malrotation at Royal Hospital for Sick Children, Glasgow (RHSC) between 1998 and 2014. RESULTS It was found that children between the ages of 28 days and 15 years are more likely to display signs and symptoms such as chronic abdominal pain and non-bilious vomiting. Their complication rate was found to be significant. CONCLUSION Education surrounding the timely diagnosis of malrotation in the post-neonatal child is crucial.
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Affiliation(s)
- Felicity Arthur
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, UK
| | - Robert Carachi
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, UK
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Husberg B, Salehi K, Peters T, Gunnarsson U, Michanek M, Nordenskjöld A, Strigård K. Congenital intestinal malrotation in adolescent and adult patients: a 12-year clinical and radiological survey. SPRINGERPLUS 2016; 5:245. [PMID: 27026938 PMCID: PMC4771654 DOI: 10.1186/s40064-016-1842-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/15/2016] [Indexed: 11/21/2022]
Abstract
Congenital intestinal malrotation is mainly detected in childhood and caused by incomplete rotation and fixation of the intestines providing the prerequisites for life-threatening volvulus of the midgut. The objective of this study was to evaluate a large cohort of adult patients with intestinal malrotation. Thirty-nine patients, 15–67 years, were diagnosed and admitted to a university setting with congenital intestinal malrotation 2002–2013. The patients were divided into three age groups for stratified evaluation. Medical charts were scrutinized, and clinical outcome of surgery was reviewed. Twelve patients presented as emergency cases, whereas 27 were admitted as elective cases. Diagnosis was established in 33 patients who underwent radiological investigation and in the remaining 6 during surgery. A Ladd’s operation was performed in 31 symptomatic patients; a conservative strategy was chosen in eight cases. Volvulus was more common in the younger age group. Twenty-six surgically treated patients were available for telephone interview, 1–12 years after surgery. All patients, except one, regarded their general condition improved to a high degree (n = 18) or with some reservation (n = 7). Twelve patients suffered remaining abdominal pain of a chronic and diffuse character. Due to recurrence of malrotation six patients were reoperated. Symptomatic malrotation occurs in both children and the adult population. Improved awareness and an accurately performed CT scan can reveal the malformation and enable surgical treatment. A Ladd’s procedure relieved most patients from their severe complaints even when a history of several years of suffering existed.
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Affiliation(s)
- Britt Husberg
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden ; Department of Surgery, Ersta Hospital, Stockholm, Sweden ; Department of Clinical Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden ; Department of Gastrointestinal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Salehi
- Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ; Unit of Paediatric Surgery, Astrid Lindgren Children Hospital, Stockholm, Sweden
| | - Trevor Peters
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University Hospital, 901 87 Umeå, Sweden
| | - Margareta Michanek
- Department of Clinical Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden ; Department of Gastrointestinal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ; Unit of Paediatric Surgery, Astrid Lindgren Children Hospital, Stockholm, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Umeå University Hospital, 901 87 Umeå, Sweden
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Heshin-Bekenstein M, Hashkes PJ. Intestinal malrotation as a misdiagnosis of pediatric colchicine resistant familial Mediterranean fever. Pediatr Rheumatol Online J 2015; 13:45. [PMID: 26554556 PMCID: PMC4641426 DOI: 10.1186/s12969-015-0044-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is a disorder characterized by recurrent attacks of fever and serosal inflammation, particularly abdominal pain. Other disease processes, including medical and surgical emergencies, may mimic FMF, especially in atypical cases. CASE PRESENTATION We present a case of an adolescent male, referred to us with a diagnosis of colchicine resistant FMF, ultimately diagnosed with intestinal malrotation and recurrent volvulus. CONCLUSIONS In atypical presentations of FMF with potential "red flags", a thorough patient history is extremely important and should result in prompt referral for the appropriate diagnostic tests.
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Affiliation(s)
- Merav Heshin-Bekenstein
- Pediatric Department, Shaare Zedek Medical Center, P.O. Box 3235, 9103102, Jerusalem, Israel
| | - Philip J Hashkes
- Pediatric Rheumatology Unit, Shaare Zedek Medical Center, P.O. Box 3235, 9103102, Jerusalem, Israel.
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Zhou LY, Li SR, Wang W, Shan QY, Pan FS, Liu JC, Xie XY. Usefulness of Sonography in Evaluating Children Suspected of Malrotation: Comparison With an Upper Gastrointestinal Contrast Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1825-1832. [PMID: 26362146 DOI: 10.7863/ultra.14.10017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to prospectively evaluate the value of sonography in working up or ruling out malrotation by 3 sonographic features (inversion of the superior mesenteric artery and superior mesenteric vein, the whirlpool sign, and an intraperitoneal transverse duodenum) and comparing it with an upper gastrointestinal (GI) contrast study. METHODS A total of 70 pediatric patients who underwent detailed abdominal sonography to rule out intestinal malrotation were included. Twenty-three of them also underwent an upper GI contrast study. Surgery or clinical follow-up was taken as the reference standard. Statistical analysis was performed with the χ(2) test. RESULTS Twenty-three patients had a diagnosis of malrotation by surgical findings. With the combination of all 3 sonographic features, the sensitivity, specificity, and accuracy of sonography for determining malrotation were 100% (23 of 23), 97.8% (46 of 47), and 98.6% (69 of 70), respectively, whereas the sensitivity, specificity, and accuracy of the upper GI study were 40% (4 of 10), 64.3% (9 of 14), and 56.5% (13 of 23; P < .001). Combined anomalies in 2 patients and complications in 2 patients were also detected by sonography. CONCLUSIONS By combining inversion of the superior mesenteric artery and superior mesenteric vein, the whirlpool sign, and an intraperitoneal transverse duodenum, sonography might be more valuable for accurately working up or ruling out pediatric malrotation than an upper GI contrast study. In addition, sonography could provide extra information, such as combined anomalies and intestinal necrosis, to help management.
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Affiliation(s)
- Lu-yao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., W.W., Q.S., F.P., X.X.) and Departments of Radiology (S.L.) and Pediatric Surgery (J.L.), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shu-rong Li
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., W.W., Q.S., F.P., X.X.) and Departments of Radiology (S.L.) and Pediatric Surgery (J.L.), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., W.W., Q.S., F.P., X.X.) and Departments of Radiology (S.L.) and Pediatric Surgery (J.L.), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Quan-yuan Shan
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., W.W., Q.S., F.P., X.X.) and Departments of Radiology (S.L.) and Pediatric Surgery (J.L.), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fu-shun Pan
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., W.W., Q.S., F.P., X.X.) and Departments of Radiology (S.L.) and Pediatric Surgery (J.L.), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun-cheng Liu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., W.W., Q.S., F.P., X.X.) and Departments of Radiology (S.L.) and Pediatric Surgery (J.L.), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-yan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., W.W., Q.S., F.P., X.X.) and Departments of Radiology (S.L.) and Pediatric Surgery (J.L.), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Abstract
PURPOSE OF REVIEW At present, there is a debate as to the management of malrotation in pediatric patients. This review highlights recent literature including the role of laparoscopy, and the management of asymptomatic patients with and without congenital cardiac disease. RECENT FINDINGS Symptomatic patients are still recommended to undergo open Ladd's procedure. Laparoscopic Ladd's procedure in asymptomatic patients confers a shorter time to tolerating feeds, shorter length of stay, and a decreased rate of bowel obstruction and other complications. It may, however, carry a higher risk of postoperative volvulus. Diagnostic laparoscopy is recommended in asymptomatic patients in whom the diagnosis is uncertain on upper gastrointestinal imaging. Asymptomatic patients with congenital heart disease may be managed with initial observation or operation, based upon individualized risk benefit assessment. If an elective Ladd's procedure is performed, it should take place after palliative cardiac operations have resulted in stable cardiac function. Screening upper gastrointestinal studies in heterotaxy patients may be unnecessary as the reported rates of volvulus in recent studies are low. SUMMARY Laparoscopic Ladd's procedure may be an acceptable alternative to an open procedure for asymptomatic patients. Observation of asymptomatic patients with congenital cardiac disease is a reasonable alternative in selected patients.
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Heterotaxy syndrome infants are at risk for early shunt failure after Ladd procedure. Ann Thorac Surg 2015; 99:918-25. [PMID: 25595831 DOI: 10.1016/j.athoracsur.2014.09.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/19/2014] [Accepted: 09/23/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiac-specific risks and complications after a Ladd procedure in patients with heterotaxy syndrome (HS) and intestinal rotational anomalies (IRA) are unknown. We sought to (1) describe rates of hospital mortality and early systemic-to-pulmonary (S-P) artery shunt failure after the Ladd procedure in patients with HS and (2) explore risk factors associated with early shunt failure in patients with HS with single ventricle (SV). METHODS This retrospective study included all Ladd procedures performed from January 1999 to December 2012 in patients with HS at a single center. Risk factors investigated for early S-P artery shunt failure included birth weight, gestational age, sex, age at and timing of Ladd procedure relative to cardiac operations, and shunt type. RESULTS Ladd procedure was performed on 54 infants with HS and congenital heart disease. Hospital mortality for the entire cohort was 5.6% (3 of 54 patients). Early shunt failure occurred in 19% (4 of 21) of HS infants with SV. Mean preoperative blood urea nitrogen (BUN) levels were higher in HS infants with early shunt failure (20 versus 12.5 mg/dL; p = 0.054). CONCLUSIONS Patients with SV and HS with S-P artery shunts are at risk for early shunt failure after a Ladd procedure. A higher mean preoperative BUN level is noted in patients with HS and early shunt failure. Careful risk-benefit analysis is indicated before recommending routine elective Ladd procedures in patients with HS.
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Abstract
OBJECTIVES Midgut volvulus with malrotation is typical in newborns. We present our experience to emphasize the importance of suspecting midgut volvulus as a cause of abdominal pain also beyond infancy, particularly in relation to malrotation, and the relevance of ultrasonographic (US) signs in its diagnosis. METHODS A total of 34 patients (10 boys, 24 girls; ages between 1 day and 12 years) diagnosed as having malrotation or malrotation with volvulus, surgically confirmed, between 2006 and 2013 were retrospectively selected among all of the patients referred to our institution for acute abdomen and bilious vomiting. All of them underwent US and color Doppler examination before surgery. The US examinations were performed with 6 to 10 MHz microconvex and 7.5 to 10 Mhz linear transducer. The transducer was placed under xiphoid, and, with axial projection, the presence of anatomic position reversed between superior mesenteric vein (SMV) and superior mesenteric artery (SMA), as a sign of malrotation, and the presence of "whirlpool sign" (WS) (wrapping of the SMV and the mesentery around the SMA), as a sign of midgut volvulus, were evaluated. RESULTS In 27 of these 34 patients, midgut volvulus was present; 7 patients had intestinal malrotation. In 2 of 7 (28%) patients with malrotation, SMA and SMV were inverted. Among the patients with volvulus, 2 showed reversed vessel position and 22 patients presented the WS in association with SMA/SMV inversion (22/27, 81%). CONCLUSIONS Midgut volvulus with malrotation can appear beyond the neonatal age group as demonstrated in our case. The WS sign is sufficiently sensitive for its diagnosis and should be routinely researched at all ages of pediatric population. Anatomic inversion between SMV and SMA seems to be not enough sensitive in isolated malrotation diagnosis.
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Aboagye J, Goldstein SD, Salazar JH, Papandria D, Okoye MT, Al-Omar K, Stewart D, Lukish J, Abdullah F. Age at presentation of common pediatric surgical conditions: Reexamining dogma. J Pediatr Surg 2014; 49:995-9. [PMID: 24888850 DOI: 10.1016/j.jpedsurg.2014.01.039] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The commonly cited ages at presentation of many pediatric conditions have been based largely on single center or outdated epidemiologic evidence. Thus, we sought to examine the ages at presentation of common pediatric surgical conditions using cases from large national databases. METHODS A retrospective analysis was performed on Healthcare Cost and Utilization Project databases from 1988 to 2009. Pediatric discharges were selected using matched ICD9 diagnosis and procedure codes for malrotation, intussusception, hypertrophic pyloric stenosis (HPS), incarcerated inguinal hernia (IH), and Hirschsprung disease (HD). Descriptive statistics were computed. RESULTS A total of 63,750 discharges were identified, comprising 2744 cases of malrotation, 5831 of intussusception, 36,499 of HPS, 8564 of IH, and 10,112 of HD. About 58.2% of malrotation cases presented before age 1. Moreover, 92.8% of HPS presented between 3 and 10weeks. For intussusception, 50.3% and 91.4% presented prior to ages 1 and 4years, respectively. Also, 55.8% of IHD cases presented before their first birthday. For HD, 6.5% of cases presented within the neonatal period and 45.9% prior to age 1year. CONCLUSION Our findings support generally cited presenting ages for HPS and intussusception. However, the ages at presentation for HD, malrotation, and IH differ from commonly cited texts.
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Affiliation(s)
- Jonathan Aboagye
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Seth D Goldstein
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Jose H Salazar
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Dominic Papandria
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Mekam T Okoye
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Khaled Al-Omar
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Dylan Stewart
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Jeffrey Lukish
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Fizan Abdullah
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
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Ozkan A, Ozaydin I, Kaya M, Kucuk A, Katranci AO. Malrotation-associated cholecystoduodenal fistula. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:18-21. [PMID: 24454977 PMCID: PMC3894915 DOI: 10.12659/ajcr.889903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022]
Abstract
Patient: Female, 16 Final Diagnosis: Malrotation and cholecystoduodenal fistula Symptoms: Abdominal pain • anorexia • fever • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Aybars Ozkan
- Department of Pediatric Surgery, Medical Faculty, Duzce University, Duzce, Turkey
| | - Ismet Ozaydin
- Department of General Surgery, Medical Faculty, Duzce University, Duzce, Turkey
| | - Murat Kaya
- Department of Pediatric Surgery, Medical Faculty, Duzce University, Duzce, Turkey
| | - Adem Kucuk
- Department of Pediatric Surgery, Medical Faculty, Duzce University, Duzce, Turkey
| | - Ali Osman Katranci
- Department of Pediatric Surgery, Samsun Education and Research Hospital, Samsun, Turkey
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36
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Current World Literature. Curr Opin Allergy Clin Immunol 2013. [DOI: 10.1097/aci.0b013e3283619e49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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