Access to emergency paediatric surgery for testicular torsion or intestinal volvulus in New Zealand: A system perspective

Castle, Cameron; Beasley, Spencer W.; Taghavi, Kiarash

doi:10.1111/jpc.15684

Cited by 2 publications

(7 citation statements)

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“…While it is universally accepted that diagnosis of malrotation with volvulus is time critical, 1 few studies have examined the timelines involved to assess for increased morbidity/mortality 7,20 . This study found no correlation between time of symptom onset and outcomes for acute presentations of children with malrotation and/or volvulus.…”

Section: Discussionmentioning

confidence: 70%

“…Just as our New Zealand colleagues found, 7 in Queensland our patients are often referred from locations significantly remote from our tertiary level hospitals. We did not, however, find delays to management (e.g.…”

Section: Discussionmentioning

confidence: 93%

“…18 Many previous studies have highlighted the importance of early recognition of symptoms, especially bilious vomiting, and referral to a tertiary paediatric surgical service for prompt management., 1,13,19 however few have examined any potential impact of the time-blocks involved. 7,20 In this study, we hypothesised delays in the recognition of symptoms by both parents and primary care practitioners, and/or delays in referral to a paediatric surgeon and subsequent management may be associated with poorer outcomes in children with malrotation AE volvulus.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…1,2 The incidence of malrotation has been reported as 1 in 500 live births, 3,4 with >50% presenting before their first birthday and approximately 75% before 5 years. [5][6][7] The true incidence is difficult to determine, however, as more recent studies suggest there may be a higher proportion of asymptomatic patients and patients identified with chronic symptoms in adulthood. 8,9 Intestinal malrotation results from abnormal embryological rotation and fixation of the bowel.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…Intestinal malrotation with midgut volvulus is a paediatric surgical emergency, requiring urgent identification and management due to the risk of significant bowel ischaemia and death 1,2 . The incidence of malrotation has been reported as 1 in 500 live births, 3,4 with >50% presenting before their first birthday and approximately 75% before 5 years 5–7 . The true incidence is difficult to determine, however, as more recent studies suggest there may be a higher proportion of asymptomatic patients and patients identified with chronic symptoms in adulthood 8,9 …”

mentioning

confidence: 99%

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No safe time window in malrotation and volvulus: A consecutive cohort study

Gibson,

Silva,

Bajaj

et al. 2024

J Paediatrics Child Health

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BackgroundMalrotation and volvulus classically present with bilious vomiting. It is more common earlier in life, but there are other causes of bile‐stained vomiting. This leads some clinicians to ‘watch and wait’. In the presence of a volvulus, this is potentially a fatal decision. It is not clear from the literature if there is a safe time window in which children can be observed in the hope of avoiding transfers or radiological investigations.AimTo determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care.MethodsMulticentre, retrospective review of all children with malrotation ± volvulus at two tertiary children's hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re‐operations and death.ResultsThere were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile‐stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post‐operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re‐operation.ConclusionMalrotation remains a time‐critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for ‘watch and wait’ for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 93%