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Malrotation, a rare cause of acute abdomen: a retrospective analysis
Metin Gündüz 1, Samet Ünal 1, Mehmet Sarıkaya 1, Fatma Özcan Sıkı 1, Saime Sündüs Uygun 2, Tamer Sekmenli 1, İlhan Çiftçi 1
1 Selcuk University Faculty of Medicine, Department of Pediatric Surgery
2 Selcuk University Medical Faculty Department of Neonatology
Aim: In this study, we aimed to evaluate the diagnostic methods, treatment results and postoperative follow-up of pediatric patients treated for malrotation.
Methods: In this study, pediatric patients who underwent surgery for malrotation between January 2018 and January 2025 were retrospectively analyzed. Data on demographic characteristics, symptoms, diagnostic approaches, surgical interventions, and postoperative outcomes were analyzed.
Results: A total of 19 patients aged between 2 days and 12 years were operated for malrotation. Fourteen of the patients (73.7%) were operated in the neonatal period. Eleven (57.9%) of the patients were boys and 8 (42.1%) were girls. The most common symptom in the neonatal group was failure to feed and vomiting with bile, which was observed in 8 patients. Non-roation anomaly was present in 4 patients with a prediagnosis of antenatal dudodenal atresia. One of the patients had anal atresia and Hirschsprung's disease. One patient with acholic stool had rotation anomaly accompanying biliary atresia. Accompanying rotation anomaly was observed in 1 patient with colonic atresia. The mean age at operation in the neonatal group was 16.4 days. The mean age at operation was 9.66 years in the non-neonatal group. The complaints in all patients were abdominal pain, bilious vomiting and distension. 10 of 20 patients (52.6%) had volvulus and the remaining 9 patients (47.4%) had malrotation anomaly which was detected during exploration for additional problems. Ladd Procedure was performed. Patients started oral feeding in an average of 7.5 days after the onset of postoperative passage patency (2-15). They were discharged on an average of 9.1 days postoperatively.
Conclusion: Malrotation may cause volvulus with a mortal prognosis, but sometimes it may be found incidentally as an accompanying condition to other diseases. Early diagnosis and treatment is vital in volvulus due to malrotation. The Ladd Procedure has been used for surgical treatment of malrotations for many years. The success of surgery is determined by the timing of surgery, comorbidities and post operative care.