Utpal Anand1, Ramesh Kumar2, Rajeev N Priyadarshi3, Bindey Kumar4, Sanjay Kumar5, Vijay Prakash Singh6. 1. Department of Surgical Gastroenterology, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India. utpalanand2@gmail.com. 2. Department of Gastroenterology, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India. 3. Department of Radiodiagnosis, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India. 4. Department of Pediatric Surgery, All India Institute of Medical Sciences, AIIMS Road, No. 1, Phulwari Sharif, Patna, 801 507, India. 5. Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Bailey Road, Raja Bazar, Sheikhpura, Patna, 800 014, India. 6. Department of Gastroenterology, Patna Medical College and Hospital, Ashok Rajpath Road, Patna University Campus, Patna, 800 001, India.
Abstract
BACKGROUND: Intestinal malrotation (IM) is an uncommon condition and has varied presentation in different age groups. The study was aimed to evaluate differences in the clinical presentation, diagnosis, treatment, and outcome of IM in infants, children, and adults. METHODS: Data were collected from records of 79 patients with IM. Based on the age of presentation, these patients were categorized into three age groups: infants (up to 1 year), children (1-18 years), and adults (> 18 years). Follow up data were analyzed during 8 to 16 year after corrective surgery. RESULTS: The overall age of presentation ranged from 8 days to 60 years. Twenty-eight, 29, and 22 patients belonged to the infant, children, and adult groups, respectively. The classical presentation of IM (bilious vomiting) was significantly higher in the infant compared to the children and adult groups (100% vs. 62% vs. 9.8%; p < 0.001). All infants presented with acute symptoms. However, children and adults had subacute or chronic presentations, respectively. The incidence of volvulus was significantly higher in the infant group than other two groups, (100% vs. 41% vs. 10%; p < 0.001). Doppler ultrasound was highly accurate in infants (100%), whereas contrast-enhanced computed tomography (CECT) abdomen was found to be most useful in adults. Postoperative complications were more common in adults. CONCLUSION: Intestinal malrotation can present in patients of any age group. An increased awareness about the atypical presentations of this condition among adults may reduce the time to accurate diagnosis of this disease.
BACKGROUND: Intestinal malrotation (IM) is an uncommon condition and has varied presentation in different age groups. The study was aimed to evaluate differences in the clinical presentation, diagnosis, treatment, and outcome of IM in infants, children, and adults. METHODS: Data were collected from records of 79 patients with IM. Based on the age of presentation, these patients were categorized into three age groups: infants (up to 1 year), children (1-18 years), and adults (> 18 years). Follow up data were analyzed during 8 to 16 year after corrective surgery. RESULTS: The overall age of presentation ranged from 8 days to 60 years. Twenty-eight, 29, and 22 patients belonged to the infant, children, and adult groups, respectively. The classical presentation of IM (bilious vomiting) was significantly higher in the infant compared to the children and adult groups (100% vs. 62% vs. 9.8%; p < 0.001). All infants presented with acute symptoms. However, children and adults had subacute or chronic presentations, respectively. The incidence of volvulus was significantly higher in the infant group than other two groups, (100% vs. 41% vs. 10%; p < 0.001). Doppler ultrasound was highly accurate in infants (100%), whereas contrast-enhanced computed tomography (CECT) abdomen was found to be most useful in adults. Postoperative complications were more common in adults. CONCLUSION: Intestinal malrotation can present in patients of any age group. An increased awareness about the atypical presentations of this condition among adults may reduce the time to accurate diagnosis of this disease.
Authors: Margarida S Ferreira; Joana Simões; António Folgado; Sandra Carlos; Nuno Carvalho; Filipa Santos; Paulo Matos Costa Journal: Int J Surg Case Rep Date: 2019-11-27