Intestinal Malrotation with Midgut Volvulus Presenting as Acute Abdomen in Children: Value of Diagnostic and Therapeutic Laparoscopy

Abstract

Intestinal malrotation is a developmental anomaly of intestinal fixation and rotation caused by a disruption in the normal embryologic development of the bowel. Normal rotation takes place around the superior mesenteric artery. Incomplete rotation and midgut volvulus is the commonest type of anomaly. Intestinal obstruction is the commonest presentation in symptomatic cases. Between 2000 and 2006, 73 children with acute abdomen underwent a diagnostic laparoscopy procedure. In this paper, we report 7 cases (9.5%) of midgut malrotation with volvulus and acute abdomen. Age range was between 7 and 12 years; there were 4 females and 3 males. They all presented with features of intestinal obstruction. A diagnosis of malrotation was established in only 1 patient, whereas the other 6 were diagnosed on laparoscopy. A laparoscopic Ladd's procedure was successfully performed for all cases. There were no postoperative complications. Intestinal malrotation occurs at a rate of 1 in 500 live births. The Ladd's procedure is the operation of choice. In 1995, the first report of laparoscopic surgery for malrotation was published. Since then, many studies were reported. Laparoscopy is a well-established diagnostic and treatment modality for this condition, even in the presence of volvulus. Our study shows the diagnostic value of laparoscopy in acute abdomen in children. The other advantages include less postoperative pain, a better cosmesis, especially in children, early return of bowel movement, and early discharge.