Malrotation In Neonate Research Articles

Current view on the diagnosis of intestinal malrotation in neonates: radiologic and ultrasound imaging techniques

Current view on the diagnosis of intestinal malrotation in neonates: radiologic and ultrasound imaging techniques

18-year-old with Abdominal Pain Due to Congenital Bowel Malrotation: A Case Report.

IntroductionCongenital bowel malrotation resulting in midgut volvulus is traditionally regarded as a diagnosis of infancy. Rarely, congenital bowel malrotation is diagnosed in adolescents or adults and requires a high index of suspicion. Presentations can be acute or chronic, and physical examination findings are nonspecific. Diagnosis is primarily achieved through abdominal computed tomography (CT) or during exploratory laparotomy. The pathophysiology in late-onset malrotation is similar to neonatal malrotation, with a division of Ladd’s bands – peritoneal fibrous bands that connect the cecum to the right lower quadrant retroperitoneum – as the definitive treatment. We present a case of congenital bowel malrotation in an adolescent with persistent and worsening migratory abdominal pain.Case ReportAn 18-year-old female presented to the emergency department with two days of poorly localized abdominal pain and nausea. Initial evaluation was unremarkable and she was discharged home with a diagnosis of constipation. She returned two days later with worsening abdominal pain and new onset emesis. Given her persistent and worsening symptoms an abdominal CT was performed, which revealed malrotation of the bowel. Taken together, her CT findings and abdominal symptoms were concerning for symptomatic congenital bowel malrotation and she underwent a Ladd procedure. She remained asymptomatic both at discharge and at two-week postoperative follow-up.ConclusionSymptomatic congenital bowel malrotation is more common in older children and adults than has traditionally been thought. Physicians must consider this diagnosis in their differential when working up a patient for acute or chronic intermittent abdominal pain to prevent potentially severe sequelae.

Laparoscopic vs open Ladd\u2019s procedure for malrotation in neonates and infants: a propensity score matching analysis

BackgroundLaparoscopic Ladd’s procedure for malrotation in children is still a controversial approach. Although some retrospective studies have compared the outcomes of the two types of procedure with inconsistency outcomes. Currently, there are few large-scale studies on laparoscopic treatment in malrotation with neonates and infants. We did a study based on propensity score matching to compare the effects of the two kinds of approach in neonates and infants. To investigate the therapeutic effect of laparoscopy and open Ladd’s procedure by the propensity score-matching (PSM) to enhance the validity of the comparison.MethodsA total series of 143 cases of intestinal malrotation without intestinal necrosis was included in the study during the 8 years from January 2012 to January 2020, including 68 cases of open Ladd’s procedure and 75 cases of laparoscopic Ladd’s procedure including five cases of transfer laparotomy. By a propensity score 1:1 matching, 62 patients were stratified for each group.Results and conclusionThere was no significant difference in volvulus degree, weight and gender between the two groups (p > 0.05). Laparoscopic surgery took more time than open surgery (105.9 min vs 70.6 min, p < 0.05), but it had less hospital stay (12.4 days vs 14.6 days, p < 0.05) or less incision infection (0 vs 6, p < 0.05). There was no significant difference between the two groups at the time of first defecation, blood loss, time of full feeding and reoperation (p > 0.05). The cosmetic effect of laparoscopic surgery is better than that of open surgery. Laparoscopic Ladd’s procedure is a safe approach. It can reduce the length of hospital stay and incision infection, but the operation time was extended, the other complications are similar compared with open procedure for intestinal malrotation in neonates and infants.

Malrotation of Small Bowel with Midgut Volvulus in a COVID-19 Positive Young Male: A Rare Case Report

Malrotation of small bowel with midgut volvulus has a very low incidence of 0.2% in adults. Symptomatic malrotation in neonates occur in one in 6000 live births. The normal 270 degrees counter-clockwise gut rotation around the axis of superior mesenteric artery is absent in such cases. A 20-year-old male presented with intermittent colicky abdominal pain since four to five months, post-prandial bilious vomiting since one week and obstipation since two days. He also had difficulty breathing since two days. Abdominal examination revealed vague lump in right lower abdomen with no signs of peritonitis. Radiological investigations Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) abdomen demonstrated over distended stomach with dilated D1 and D2 showing changes in relation to superior mesenteric artery and superior mesenteric vein with rotation of mesentery in whirlpool pattern. His Reverse Transcriptase-Polymerase Chain Reaction Test (RT-PCR) was positive for Coronavirus Disease-2019 (COVID-19). Conservative trial for two days was followed by surgical exploration which revealed gut malrotation with mid-gut volvulus. Ladd’s procedure was performed. Malrotation with midgut volvulus is an acute surgical emergency that demands high index of suspicion in an adult. Associated COVID-19 pneumonia can increase mortality. Patient was followed-up after three weeks with fruitful results, proving that an early diagnosis and definitive surgical correction of malrotation with midgut volvulus is essential.

Atypical presentation of concurrent duodenal web and malrotation

Intestinal malrotation in neonates is well known with incidence of 1:500 and symptomatic incidence 1:6000 births. Duodenal web as a cause of intestinal obstruction is less common with incidence of 1:10000–1:40000. Intestinal obstruction due to duodenal web associated with malrotation is very rare and only few case reports published in the literature. In this report we present a case of a 2.5 year old female child with duodenal obstruction due to concurrent duodenal web and malrotation and discussed its management.

The role of sonography for depiction of a whirlpool sign unrelated to midgut malrotation in neonates

The sonographic whirlpool sign of volvulus due to midgut malrotation is well recognized. However, variations of the whirlpool sign may be seen in other conditions, but this observation has received little attention in the literature. This study presents a series of neonates with a variety of causes of congenital intestinal obstruction, all associated with a whirlpool sign (unrelated to midgut volvulus), which was correctly recognized preoperatively on sonography. We also emphasize the pivotal role of sonography in managing congenital obstruction of the intestinal tract in neonates. This is a retrospective analysis of clinical, imaging and surgical findings in 11 neonates with congenital intestinal obstruction associated with a whirlpool sign (unrelated to midgut volvulus) that was recognized preoperatively on sonography and in whom the cause for the whirlpool was documented at surgery. Eleven neonates (eight male, three female) had clinical and radiographic evidence of intestinal obstruction in whom sonography depicted a whirlpool sign, which was recognized on the initial sonogram in nine and on a repeat sonogram in two. The whirlpool was located in the upper abdomen in only two, mid-abdomen in five and right lower quadrant in four. The whirlpool was only 1-2cm in diameter. An upper gastrointestinal series in three neonates failed to depict the cause of obstruction. Contrast enema in three cases had findings suggesting the site of obstruction was in the ileum but none depicted the exact cause of the obstruction. At surgery, the whirlpool sign correlated with a segmental volvulus of the small intestine in eight neonates and with the coiled distal small intestine associated with apple-peel atresia in the other three. This study illustrates neonates in whom a whirlpool sign (unrelated to midgut volvulus) was correctly recognized on sonography before surgery. Sonography proved more useful than an upper gastrointestinal series or contrast enema in depicting the exact cause of the obstruction. Pediatric radiologists must make the effort to search throughout the entire abdomen and pelvis for a small whirlpool sign on sonography, even in the absence of midgut malrotation, in neonates with congenital intestinal obstruction. Its recognition preoperatively will facilitate a rapid diagnosis and will obviate the necessity for contrast examinations of the gastrointestinal tract, which require ionizing radiation.

Complications after laparoscopic Ladd operation for intestinal malrotation in neonates

To analyze complications after laparoscopic Ladd operation for intestinal malrotation, related causes and possible solutions. Clinical data of 81 neonates who underwent laparoscopic Ladd operations for intestinal malrotation in the Children's Hospital, Zhejiang University School of Medicine between January 2015 and January 2018 were reviewed. The abdominal complications and findings during operation and reoperation were analyzed. Operations were successfully completed in all patients, and there was no patient converted to open surgery. The annular pancreas in 6 cases and duodenal diaphragm in 4 cases were confirmed during the operation. The recurrent volvulus developed in 3 patients (3.7%), of whom 2 cases were confirmed to have midgut necrosis during open surgery 1 week and 3 months after laparoscopic Ladd operation, and both finally died; 1 case was corrected by second laparoscopic operation. Cecal perforation occurred in 1 patient (1.2%), which was caused by intensive high frequency coagulation of the appendiceal stump. One patient (1.2%) developed chylous ascites and improved after conservative treatment. Adhesive small bowel obstruction was observed in 3 cases (3.7%), and all relieved after conservative treatment. Laparoscopic Ladd operation for intestinal malrotation in neonates was effective, and the incidence of abdominal complications may be minimized by experienced skills and strict perioperative management.

Polymorphism analysis of exons 2 and 5 of PITX2 gene of neonatal intestinal malrotation

Objective To screen the neonatal malrotation with PITX2 gene exon 2 and 5 gene mutation through the study on molecular genetics. Methods From January 2012 to December 2014, 15 cases of neonatal malrotation infants(experimental group)and 25 healthy newborn infants(healthy control group) were selected as the research subjects from the First Affiliated Hospital of Shihezi University Medical College.The experimental group included 15 cases of volvulus, 4 cases of volvulus with duodenal atresia and 3 cases of volvulus with jejunal atresia.The clinical features were recorded and 3 mL peripheral venous blood from each subject was collected.After ethylenediamine tetraacetic acid (EDTA) anticoagulation, genomic DNA was extracted.Polymerase chain reaction (PCR) was used to amplify the exon 2 and exon 5 of PITX2 gene, and the direct sequencing method was used to screen whether there were mutations in these 2 loci. Results According to the findings of the matching gene, PITX2 gene exon 2 and exon 5 mutations were not detected in 15 cases with intestinal malrotation of the experimental group and 25 healthy newborns in the healthy control group. Conclusions Polymorphisms is not detected in PITX2 gene exon 2 and exon 5 in small groups of newborn, but this does not exclude the possibility the gene caused newborns suffering from intestinal malrotation by other means. Key words: Infant, newborn; Intestinal malrotation; PITX2 gene; Gene mutation

Laparoscopic repair of malrotation: what are the indications in neonates and children?

To define the role of laparoscopy for treating malrotation in children. The Ladd procedure (9 laparoscopic [lap-Ladd], 17 open [open-Ladd]; n=26) was performed in children up to and including 30 days of age (neonatal [Group N]) and older (Group C). These groups were compared retrospectively. Group N (n=14) comprised 3 lap-Ladd and 11 open-Ladd patients. Group C (n=12) comprised 6 lap-Ladd and 6 open-Ladd patients. No case had ischemic bowel preoperatively. Intestinal volvulus was confirmed in 3 of 3 lap-Ladd and 9 of 11 open-Ladd patients in Group N, compared with 5 of 6 lap-Ladd and 6 of 6 open-Ladd patients in Group C (P=not significant). Mean operating times were significantly longer for lap-Ladd patients (130.7 minutes versus 81.1 minutes in Group N and 119.2 minutes versus 74.2 minutes in Group C). Conversion to an open-Ladd procedure was necessary in 1 of 3 patients in Group N and 1 of 6 patients in Group C (P=not significant). Complications arose in open-Ladd patients, bowel obstruction in Group N (1 of 11), and mesenteric chylorrhea in Group C (1 of 6). There was recurrence in 1 of 3 lap-Ladd patients in Group N. Mean time to recommence feeding was earlier for lap-Ladd patients (P=not significant). Length of hospitalization was similar in Group N but was shorter for lap-Ladd patients in Group C (P=not significant). Although lap-Ladd appears to be a safe procedure, it cannot be recommended for the treatment of malrotation in neonates.

Duodenal web associated with malrotation and review of literature

Intestinal obstruction due to midgut malrotation in neonates is well known. The incidence of malrotation in newborns is around 1:500 and the symptomatic incidence is 1:6000 births. Duodenal web as a cause of intestinal obstruction is less common and is reported to be 1:10 000–1:40 000. Malrotation is known to be associated with other congenital obstructive anomalies including duodenal atresia, stenosis and duodenal web. But, intestinal obstruction due to malrotation associated with duodenal web has been reported only rarely with a few published cases in our literature review. We present a case of intestinal obstruction diagnosed in the prenatal period via sonogram. A plain X-ray of the abdomen after birth showed a distended duodenum with paucity of air distally suggesting duodenal obstruction. An exploratory laparotomy showed a duodenal web proximal to the sphincter of oddi. The patient also had an associated malrotation and underwent Ladd's procedure and appendectomy. The post-operative period was uneventful.

Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study

BackgroundIntestinal malrotation in neonates or infants may require urgent surgical treatment, especially when volvulus and vascular compromise of the midgut are suspected. Successful laparoscopic management of malrotation has been described in a number of case reports. It remains unclear, however, whether laparoscopy for the treatment of malrotation has a success rate equal to that of open surgery and what relative risks exist in terms of conversion and redo surgery in larger numbers of patients. This report describes a retrospective analysis of the clinical outcome for 45 children who underwent laparoscopic treatment of intestinal malrotation at the authors’ institution.MethodsThe 45 patients in this series, ages several days to 13 years, underwent a diagnostic laparoscopy for suspected intestinal malrotation. For 37 patients, malrotation with or without volvulus was diagnosed. All these patients underwent laparoscopic derotation and Ladd’s procedure.ResultsSuccessful laparoscopic treatment of intestinal malrotation could be performed in 75% of the cases (n = 28), and conversion to an open procedure was necessary in 25% of the cases (n = 9). The median hospital stay was 11 days (range, 2–60 days). Postoperative clinical relapse due to recurrence of malrotation, volvulus, or both occurred for 19% of the laparoscopically treated patients (n = 7). These patients underwent laparoscopic (n = 1) or open (n = 6) redo surgery.ConclusionDiagnostic laparoscopy is the procedure of choice when intestinal malrotation is suspected. If present, malrotation can be treated adequately with laparoscopic surgery in the majority of cases. Nevertheless, to prevent recurrence of malrotation or volvulus, a low threshold for conversion to an open procedure is mandated.

Atypical Malrotation in Neonates : A Report on Two Cases

Atypical Malrotation in Neonates : A Report on Two Cases