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Congenital intestinal malrotation as the serious cause of neonatal intestinal obstruction

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Author(s): H Nahvi | J Ahmadi | M Kalantari | M Molaeian | A Sedighi | H Poorang | G Khorgami | V Mehrabi

Journal: Iranian Journal of Pediatrics
ISSN 2008-2142

Volume: 15;
Issue: 3;
Start page: 215;
Date: 2005;
Original page

Keywords: Mid gut | Volvolus | Short bowel syndrome

ABSTRACT
Background: Congenital intestinal malrotation as an abnormal embryonic intestinal rotation and fixation leads to various clinical presentations of high complete or incomplete intestinal obstruction, especially midgut volvulus and extensive intestinal loss that may cause short bowel syndrome or death of the patient. we conducted this study to assay clinical presentations, surgical findings, mode of management and outcome of neonates with intestinal malrotation. Methods: We studied retrospectively data of 25 neonates with intestinal malrotation in 3 hospitals of the Tehran University of Medical Sciences (1985-2003). Results: Patients consisted of 17 males and 8 females. 5 (24%) patients had extensive intestinal gangrene that resulted in short bowel syndrome in 2 patients. 7 (20%) patients died, 5 of them due to intestinal volvolus and 2 other due to associated anomalies and sepsis. Most common clinical signs and symptoms were vomitus (96%), bilious vomiting (80%), constipation (24%),), coliky abdominal pain (23%). Abdominal distention was observed only in patients with volvolus (38%). Obstipation (31%) and rectorragia were seen only in patients with volvolus and intestinal gangrene. 28% of neonates had associated anomalies. Malrotion was suggested by abdominal X-ray in 3 out of 12 (25%), barium enema in 9 out of 11 (81.8%), and gastrointestinal follow through in 3 out of 4 (75%) examinations. 3 patients were surgically managed according to only one abdominal X-ray. Ladd procedure was performed in all patients and other necessary corrective operations for associated anomalies included intestinal resection with anastomisis in 5 and intestinal resection with entrostomy in 2 cases. Conclusion: To prevent extensive intestinal loss due to intestinal volvolus in neonates with abrupt bilious vomiting, malrotation must be excluded, and if a volvulus is suspected, emergency laparotomy should be undertaken.

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