Malrotation in Adult Patients and Associated Outcomes: A Single Institution Review

Abstract

INTRODUCTION: Malrotation classically presents with bilious emesis in children and can be life-threatening. Data on adults with malrotation is lacking. METHODS: In a single institution, retrospective 20-year data collection, adult patients (>18 years) with malrotation were included. We evaluated demographics, presentation, pre- and postoperative course, and short- and long-term outcomes. Descriptive statistics are presented. RESULTS: All 17 patients (average age 42 ± 16, 76% white, 65% female, 41% Medicare/Medicaid) with malrotation underwent surgery. No patients presented with bilious emesis, but 94% presented with abdominal pain, 12% chronic (>1 year), and 70% with abdominal pain and nonbilious emesis. Approximately 24% had additional studies (upper gastrointestinal series, x-rays) before CT scan which confirmed the diagnosis. Delay to operative exploration was identified in 65% with a wide range of timing (2 weeks to 3 years). Subgroup analysis showed 35% having surgery within 1 week of diagnosis. Adult surgeons performed 65% of the operations. Laparoscopy was completed in 18%, and 82% were open. Postoperative ileus (average 7 days ± 1.4) was noted in 41% of patients. Readmission rate was 24% and 6% required reoperation for lysis of adhesions. The majority of patients with follow-up had resolution of pain (88%). CONCLUSION: In the largest series of adult patients with malrotation, atypical presentations with abdominal pain rather than bilious emesis were ubiquitous, requiring CT scan for diagnosis. Delayed repair was common by both adult and pediatric surgeons. Preference tended to open approach. Although postoperative ileus was prevalent, most patients had resolution of abdominal pain at postoperative follow-up.