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Long-term complications following operative intervention for intestinal malrotation: a 10-year review

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Intestinal malrotation associated with a volvulus requires immediate surgical intervention. The long-term sequelae of Ladd’s procedure and its complications are not well defined. We designed this study to investigate the long-term complications following operative intervention for intestinal malrotation. Patients who have undergone a Ladd’s procedure for malrotation from January 1999 till December 2008, from two tertiary centres, were identified using the Hospital Inpatient Enquiry system. Charts were analysed to obtain information about mode of presentation, method of diagnosis and postoperative outcomes. Patients were contacted for follow-up. One hundred and sixty-one patients were identified over the 10-year period with a postoperative follow-up time ranging from 2 months to 10 years. The median age at surgery was 9 days (1 day–12 years); 38 (23%) underwent elective Ladd’s procedure for malrotation. Thirty-eight patients had intraoperative incidental findings of a malrotation during different procedures; 120 (74.5%) patients were performed as an emergency procedure. Fourteen patients (8.7%) developed complications following surgery. Nine patients developed adhesive small bowel obstruction, five required operative adhesiolysis having failed conservative treatment. There was one case of recurrent volvulus and three mortalities in our series. In our experience, looking at 161 patients with a mean follow-up of 5 years Ladd’s procedure has a low postoperative morbidity and remains a vital treatment for malrotation in children.

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  1. Ladd WE (1936) Surgical diseases of the alimentary tract in infants. N Engl J Med 215:705–708

    Article  Google Scholar 

  2. Dott NM (1923) Anomalies of intestinal rotation: their embryology and surgical aspects: with report of five cases. Br J Surg 11:251–286

    Article  Google Scholar 

  3. Ladd WE (1932) Congenital obstruction of the duodenum in children. N Engl J Med 206:277–283

    Google Scholar 

  4. Torres AM, Ziegler MM (1993) Malrotation of the intestine. World J Surg 17:326–331

    Article  CAS  PubMed  Google Scholar 

  5. Maxson RT, Franklin PA, Wagner CW (1995) Malrotation in the older child: surgical management, treatment, and outcome. Am Surg 61:135–138

    CAS  PubMed  Google Scholar 

  6. Welte FJ, Grosso M (2007) Left-sided appendicitis in a patient with congenital gastrointestinal malrotation: a case report. J Med Case Rep 1:92

    Article  Google Scholar 

  7. Zerin JM, DiPeitro MA (1992) Superior mesenteric vascular anatomy at US in patients with surgically proved malrotation of the midgut. Radiology 183:693–694

    CAS  PubMed  Google Scholar 

  8. Zerin JM, DiPeitro MA (1991) Mesenteric vascular anatomy at CT: normal and abnormal appearances. Radiology 179:739–742

    CAS  PubMed  Google Scholar 

  9. Zissin R, Rathaus V, Oscadchy A et al (1999) Intestinal malrotation as an incidental finding on CT in adults. Abdom Imaging 24:550–555

    Article  CAS  PubMed  Google Scholar 

  10. Lin JN, Lou CC, Wang KL (1995) Intestinal malrotation and midgut volvulus: a 15-year review. J Formos Med Assoc 94(4):178–181

    CAS  PubMed  Google Scholar 

  11. Seashore JH, Touloukian RJ (1994) Midgut volvulus: an ever-present threat. Arch Pediatr Adolesc Med 148:43–46

    CAS  PubMed  Google Scholar 

  12. Stauffer UG, Herrmann P (1980) Comparison of late results in patients with corrected intestinal malrotation with and without fixation of the mesentery. J Pediatr Surg 15:9–12

    Article  CAS  PubMed  Google Scholar 

  13. Mehall JR, Chandler JC, Mehall RL et al (2002) Management of typical and atypical intestinal malrotation. J Pediatr Surg 37:1169–1172

    Article  PubMed  Google Scholar 

  14. Feitz R, Vos A (1997) Malrotation: the postoperative period. J Pediatr Surg 32:1322–1324

    Article  CAS  PubMed  Google Scholar 

  15. Murphy FL, Sparnon AL (2006) Long-term complications following intestinal malrotation and the Ladd’s procedure: a 15 year review. Pediatr Surg Int 22:326–329

    Article  PubMed  Google Scholar 

  16. Schultz LR, Lasher EP, Bill AH (1961) Abnormalities of rotation of the bowel. Am J Surg 101:128–133

    Article  CAS  PubMed  Google Scholar 

  17. Hiroshi K, Tadashi I (2005) Recurrent midgut volvulus with intestinal malrotation. Jpn J Pediatr Surg 37:813–818

    Google Scholar 

  18. Panghaal V, Levin TL, Han B (2008) Recurrent midgut volvulus following a Ladd procedure. Pediatr Radiol 38:471–472

    Article  PubMed  Google Scholar 

  19. Malek MM, Burd RS (2005) Surgical treatment of malrotation after infancy: a population-based study. J Pediatr Surg 40:285–289

    Article  PubMed  Google Scholar 

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Correspondence to Yousef El-Gohary.

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El-Gohary, Y., Alagtal, M. & Gillick, J. Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int 26, 203–206 (2010).

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