Post- Infantile Presentation of Intestinal Malrotation

Objectives: To study intestinal malrotation presenting after the age of one year, analyze the spectrum of presentations and to predict risk of volvulus Design: Retrospective study Setting: Zagazig University Hospitals (Egypt) and King Fahd Hospital, Saudi Arabia Subjects: All cases (54) of malrotation during April 2006 to April 2010 Intervention(s): Analysis of clinical, radiological and operative data Main Outcome Measures: Presentation, significant associations and risk of volvulus Results: The mean age was 4.8 +/- 2.13 years. Presentations included acute volvulus (n = 27, 50\%), chronic volvulus (4, 7.5 \%), mesocolic hernia (4, 7.5 \%), intussusception (5, 9\%), exomphalos (5, 9\%) and non-specific presentation (9, 17\%). Associated anomalies were found in 19 cases (35\%) with significant association of chronic volvulus and exomphalos. Typical anatomical malrotation was seen in 21 (39\%) cases with significant risk of volvulus (odds ratio 9.2). Nausea and vomiting, abdominal colic, and malnutrition were dominant in acute and chronic volvulus, mesocolic hernia and intussusception (p < 0.05). Malnutrition and gastroesophageal reflux disease (GERD) were significantly associated with chronic volvulus (p < 0.05). Duodenal obstruction was significantly evident in acute volvulus while high cecum was dominant in intussusception. Prolonged ileus and persistent symptoms were significant in chronic volvulus and mesocolic hernia (p < 0.05), while wound infection and short bowel syndrome were significant in acute volvulus. Conclusion: Malrotation in the post-infantile period has a wide spectrum and non-specific presentation. Risk of midgut volvulus is present, especially in typical cases, and trials must be done to predict the risk and avoid unnecessary surgery.