K. T. Gemayel1, G. Romero-Velez2, S. Burjonrappa1 1University Of South Florida College Of Medicine,Department Of Pediatric Surgery,Tampa, FL, USA 2The Children’s Hospital at Montefiore,Department Of Pediatric Surgery,Bronx, NY, USA
Introduction:
Midgut malrotation is a congenital anomaly of intestinal rotation and fixation where in an incomplete rotation or a complete failure of rotation of the primitive intestinal loops around the superior mesenteric artery axis occur during the fetal period. We have personally evaluated two adolescent cases of malrotation, and it is the intent of this review to further investigate the intraoperative presentation and clinical symptoms of adolescent malrotaion in addition to our findings. Adolescent and adult age malrotation are difficult to diagnose clinically and the focus of this case series and systematic review is malrotation after the age of 1 year and inclusive of the adolescent population.
Methods:
To further evaluate intraoperative findings and clinical symptoms associated with adolescent malrotation, systematic analysis was done using Cochrane, Medline and Pubmed databases. Database search was guided using keywords “malrotation”, “volvulus”, “Ladd’s procedure”, “pediatrics”, and “adolescent”. Inclusion criteria were selected based on case series in the English language, with patients in-between 1-19 years of life, with clear cut description of intraoperative findings with perioperative evaluation. Exclusion criteria was non-English literature, age under 1 year and older than 19 years without a clear cut description of findings. Operative findings were categorized based on Stringer’s classification of malrotation, with type II and III essentially representing pre-axial and post-axial malrotation.
Results:
Systematic review yielded 75 cases in which were distributed by Stringer's classification into norotation (n= 14), duodendal malrotation (n= 37), duodenal and cecal malrotation (n= 24). Intraoperative findings were analyzed for presence of volvulus, narrow mesenteric base and presence of Ladd Bands with varying clinical symptoms (as shown in figure).
Conclusion:
In conclusion, in the case of intermittent intestinal obstruction in young adults, physicians should keep in mind that early and accurate diagnosis of malrotation with an appropriate surgical treatment may save patients from unexpected complications. Due to the presence of atypical symptoms, the diagnosis of malrotation requires a high index of suspicion, appropriate diagnostic studies, and aggressive definitive surgical treatment.
