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396 Intestinal Malrotation and Midgut Volvulus
Prevention Table 65.1: Evidence-based research.
There are no preventive measures to take regarding this disease process. Title Malrotation and volvulus in infancy and childhood
Early detection and treatment are the only measures to help prevent a Authors Millar AJW, Rode H, Cywes S
poor outcome from malrotation with volvulus.
Institution University of Cape Town and Red Cross Children’s Hospital,
Ethical Issues Rondesbosch, Cape Town, South Africa
The patient with short bowel syndrome as a result of malrotation with Reference Sem Pediatr Surg 2003; 12:229–236
volvulus that occurred either in utero or in the neonatal period presents Problem Review of malrotation and volvulus.
a real treatment challenge in the industrialised nations and may be even Intervention Diagnostic radiology and surgical treatment.
more difficult in countries where resources are more limited. These Comparison/ Comparison of recent cases with previously published
patients require TPN and significant medical care to prevent dehydra- control cohort.
tion and failure to thrive. In addition, these patients require central lines (quality of
for prolonged periods of time and are often plagued by complications evidence)
from the central lines.
Historical A large series of patients reviewed for presenting symptoms,
Evidence-Based Research significance/ evaluation, and surgical management.
In the absence of comparative studies, a recent review of malrotation comments
and volvulus is shown in Table 65.1.

Key Summary Points

1. Malrotation is a spectrum of anatomic abnormalities related to 5. Ladd’s procedure for malrotation includes detorsion of volvulus
fixation of the intestinal tract. if one is present, lysis of dense fibrous bands (Ladd’s bands),
placement of small bowel and large bowel in abdomen in
2. Bilious emesis in a newborn should be considered midgut
volvulus until proven otherwise. nonrotated manner, and appendectomy.
3. A prompt diagnostic UGI study should be done on any newborn 6. There is an increased mortality for malrotation in younger patients,
patients with clinical abnormalities, or those with bowel necrosis.
with bilious emesis to rule out malrotation with midgut volvulus.
4. If investigative studies cannot be done, then the patient should 7. Patients may have a delay in the return of bowel function after
surgery, especially if volvulus was present.
have fluid resuscitation and prompt surgical exploration to
prevent the catastrophic complications of midgut volvulus.

References

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