K. Patel1, S. Sanyal1, S. Burjonrappa1 1Robert Wood Johnson – UMDNJ, Pediatric Surgery, New Brunswick, NJ, USA
Introduction:
Intestinal malrotation occurs when there is an interruption of normal intestinal rotation between the 6th to 12th weeks of gestation. Depending on what stage of rotation is affected, malrotation can be classified into three main categories according to Stringer’s classification: Type I (non-rotation), Type II (duodenal or reverse rotation), and Type III (duodenal and cecal malrotation). Complications from malrotation may include small bowel obstruction secondary to Ladd bands and midgut volvulus which requires emergent surgical intervention. Our objective was to quantify the risk of developing symptoms and complications in varying degrees of intestinal malrotation.
Methods:
We conducted a systematic review using Medline(PubMed), Cochrane, and Embase databases and a combination of MeSH terms and keywords. Inclusion criteria included manuscripts in the English language, published between 2012-2023, and a patient population of 0 – 18 years with a diagnosis of malrotation. Two reviewers independently screened articles for retrieval. During the full-text screening stage, articles were excluded if there were no clear descriptions of intra-operative findings, the type of malrotation was not identifiable, or there were no descriptions of pre-operative symptoms. A normal distribution of cases in the population was assumed to associate the risk of symptoms and intra-operative findings with the type of malrotation. Descriptive statistics and Chi-Square test for differences in categorical data between three disparate groups was used to determine statistical significance.
Results:
After a thorough search of the databases and screening for inclusion and exclusion, 82 articles were retrieved, which included a total of 99 patients distributed by Stringer’s classification: Type 1(n=27), Type II(n=2), and Type III(n=63). Bilious vomiting was noted in 3(11%) Type I, 5(56%) Type II, and 25(40%) Type III (p=0.010). Abdominal pain was present in 13(48%) Type I, 2(22%) Type II, and 40(63%) Type III patients (p=0.044), and abdominal distension was observed in 3(11%) Type I, 4(44%) Type II, and 30(48%) Type III (p=0.004). When assessing for complications, midgut volvulus was found in 2(7%) Type I, 6(67%) Type II, and 20(32%) Type III patients (p=0.002), and intestinal obstruction in 4(15%) Type I, 7(78%) Type II, and 35(56%) Type III patients (p=0.0003).
Conclusion:
While higher rates of complications were noted in patients with Type II and III malrotation, about half of the patients with Type I malrotation presented with abdominal pain. Understanding these possible risks of symptoms or complications based on different types of intestinal malrotation can help guide clinicians in screening, observational, and surgical decisions.
