25 PERSISTENT FEEDING PROBLEMS AFTER CORRECTION OF INTESTINAL MALROTATION – MANOMETRIC ASSESSMENT

Abstract

Top of pageAbstract The introduction of feeds after correction of a midgut malrotation is usually uneventful but may be difficult in a small number of cases. The nature or the intrauterine migration defect is unknown. We assessed small intestinal motor activity manometrically in five children (mean age 13.6 mths) with persistent feeding problems after correction at a mean time of 13.0 mths after surgery. Two groups were noted. Four children with persistent vomiting did not tolerate oral feeds. All of these had a second surgical procedure attempting to relieve an obstruction (2 a pyloromyotomy, 1 an ileocaecal resection, 1 an ileostomy) but continued to have symptoms. Tnree had abnormal small intestinal motility, one no activity, one slow Phase III pressure wave frequency with short Phase III duration, and one non-propagated Phase III complexes with a low motility index (MI). One child (number 5) had severe diarrhoea after feeds due to a short bowel syndrome following an ileal resection after a volvulus. This child had a low motility index in Phase III. Tnese data show that a pattern of motor activity similar to that seen in intestinal neuropathic disorders is present in these patients. We speculate that the malrotation is secondary to a neuropathic disorder present during early foetal development in some patients.