Segmental small-bowel volvulus not associated with malrotation in childhood

Abstract

During the last 15 years, 38 children with volvulus of the intestine were treated in our hospital. Twenty-eight (73.7%) had midgut volvulus with malrotation, including 2 cases of isolated incomplete rotation of the duodenum; 10 (26.3%) had segmental volvulus of the ileum without malrotation, 3 of them assumed to be secondary to a duplication cyst, retroperitoneal band, or meconium plug; in the remaining 7 no causative abnormality was found. Nine were neonates, 8 of whom presented within the first 48 h after birth. The remaining patient was a 5-year-old girl. In all cases the correct preoperative diagnosis was not made, but obstruction or coiling of the distal ileum was demonstrated by contrast enemas in 5. Ischemic changes of the affected bowel were seen in 90% of the cases without malrotation. This contrasts with an 18% incidence in the cases with malrotation, and indicates the necessity of early diagnosis and operation. All patients required bowel resection and 2 died of sepsis after the operation, however, none suffered from short-bowel syndrome.