Document Type : case report
Authors
1 Associate Professor, Department of Paediatric Surgery, Dr RML Institute of Medical Sciences, Lucknow, India.
2 Assistant Professor, Department of Paediatric Surgery, Dr RML Institute of Medical Sciences, Lucknow, India.
3 Junior Resident, Department of Surgery, NIMS College, Jaipur, India.
4 Additional Professor, Department of Paediatric Surgery, Dr RML Institute of Medical Sciences, Lucknow, India.
Abstract
Background: Intestinal malrotation presents with symptoms that can be easily confused with other non-surgical conditions in children. In this case series, we aimed to increase awareness about this condition for its early recognition and management; and contribute to the current knowledge on this condition.
Case report: In this case series, we present five cases of Intestinal malrotation where the diagnosis was not suspected by the primary physicians. They subsequently had delayed surgical referral leading to morbidity and mortality.
Conclusion: Intestinal Malrotation in older children is usually not suspected due to atypical symptoms. Its diagnosis should be considered in older children with recurrent abdomen pain, especially if there is an associated history of malnutrition or poor weight gain. Early identification of malrotation by the attending physicians is of utmost importance. The patient should be referred for early surgical intervention to prevent morbidity and mortality. Education related to the timely diagnosis of malrotation in older children is crucial.
Keywords
- Filston HC, Kriks DR. Malrotation:the ubiquitous anamoly. J Ped Surg. 1981; 16(4):614-20.
- Torres AM, Ziegler MM. Malrotation Of the intestine. World J Surg.1993; 17(3):326-31.
- Balraj AT, Srinivas S, Reddy KR, Reddy MG, Inugala A.Malrotation presenting beyond infancy: a clinical study. Int Surg J 2018; 5:3288-91.
- Nagdeva NG, QureshiAM, BhingarePD, ShindeSK. Malrotation beyond infancy.J Ped Surg. 2012; 47:2026-32.
- Penco JMM, Murillo JC, Hernández A, Calle Pato UDL, Masjoan DF, Aceituno FR. Anomalies of intestinal rotation and fixation, consequences of late diagnosis beyond 2yrs of age, Pediatr Surg Int.2007;23:723-30.
- Penco JM, Murillo JC, Hernández A, De La Calle Pato U, Masjoan DF, Aceituno FR. Anomalies of intestinal rotation and fixation: Consequences of late diagnosis beyond two years of age. Pediatr Surg Int. 2007; 23:723–30.
- Durkin ET, Lund DP, Shaaban AF, Schurr MJ, Weber SM. Age-related differences in diagnosis and morbidity of intestinal malrotation. J Am Coll Surg. 2008; 206:658–63.
- Menghwani H, Piplani R, Yhoshu E, Jagdish B, Sree BS. "Delayed presentation of malrotation: Case series and literature review." Journal of Indian Association of Pediatric Surgeons, vol. 28, no. 4, July-Aug. 2023, p. 271.
- Jay Lodhia, Ellyagape Urassa, Abednego Mashambo, Adnan Sadiq, Joshua Tadayo, David Msuya, Late presentation of midgut malrotation with obstruction in a child, Journal of Pediatric Surgery Case Reports, Volume 84, 2022, 102353.
- Stewart DR, Colodny AL, Daggett WC. Malrotation of the bowel in infants and children: A 15 year review. Surgery. 1976; 79:716–20.
- Anand U, Kumar R, Priyadarshi RN, Kumar B, Kumar S, Singh VP. Comparative study of intestinal malrotation in infant, children, and adult in a tertiary care center in India. Indian J Gastroenterol. 2018; 37:545–9.
- Palanivelu C, Rangarajan M, Shetty AR, Jani K. Intestinal malrotation with midgut volvulus presenting as acute abdomen in children: Value of diagnostic and therapeutic laparoscopy. J Laparoendosc Adv Surg Tech A. 2007; 17:490–2.
- Penco JM, Murillo JC, Hernández A, De La Calle Pato U, Masjoan DF, Aceituno FR. Anomalies of intestinal rotation and fixation: Consequences of late diagnosis beyond two years of age. Pediatr Surg Int. 2007; 23:723–30.
- Nagdeve NG, Qureshi AM, Bhingare PD, Shinde SK. Malrotation beyond infancy. J Pediatr Surg. 2012; 47:2026–32.
- Nehra D, Goldstein AM. Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery. 2011 Mar; 149(3):386-93.
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