Assessment of care timelines in intestinal malrotation with volvulus: A retrospective chart review

Sabac, Denise; Briatico, Daniel; Fitzgerald, Peter

doi:10.1016/j.jpedsurg.2023.01.029

Cited by 3 publications

(7 citation statements)

References 17 publications

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“…Regarding the time blocks in patient management, several variables included time and location of initial presentation, US and UGI studies, and surgical consultation. Sabac et al ( 26 ) reported that the median time from initial physician assessment and surgical consultation to surgical incision was over 14 h. The present study did not analyze the effects of these variables on the time to diagnosis. Predicting which patients will develop massive intestinal necrosis is difficult ( 44 ), multicenter clinical trials are needed to further assess how long a patient could stand volvulus and help create optimal strategies for malrotation ( 26 ).…”

Section: Discussionmentioning

confidence: 68%

“…Although a diagnosis of malrotation should always be considered in children with bile-stained vomiting at any age ( 20 , 26 , 32 ), more than 10% of neonates in our study presented with symptoms of non-bilious vomiting. Similarly, bilious vomiting occurred in only 63.16% of non-neonatal patients, and other symptoms included diarrhea, small intestinal obstruction, malnutrition, and failure to thrive, making the diagnosis of malrotation more difficult ( 2 , 14 , 22 , 28 , 32 ).…”

Section: Discussionmentioning

confidence: 77%

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Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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BackgroundIntestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of malrotation in children.MethodsClinical data, imaging, operative findings, and early postoperative outcomes of 75 children with malrotation were retrospectively analyzed.ResultsThe mean age was 6.18 ± 4.93 days and 51.26 ± 70.13 months in the neonatal group (56 patients) and non-neonatal group (19 patients), respectively. Sixty-seven patients were under the age of 1 year at the time of diagnosis. The occurrence of bilious vomiting and jaundice was significantly higher in the neonatal group (89.29%) than that in the non-neonatal group (37.5%), p < 0.05 and p < 0.01, respectively. The incidence of abnormal ultrasound (US) findings was 97.30% and 100%, respectively, and the sensitivities of the upper gastrointestinal series were 84.21% and 87.5%, respectively. Sixty-six (88%) patients had midgut volvulus, including in utero volvulus (two patients) and irreversible intestinal ischemia (four patients). Most neonates (89.29%) underwent open Ladd's procedure with a shorter operative time (p < 0.01). Reoperation was performed for postoperative complications (four patients) or missed comorbidities (two patients).ConclusionsNon-bilious vomiting was the initial symptom in >10% of neonates and nearly 40% of non-neonates. This highlights the importance for emergency physicians and surgeons to be cautious about ruling out malrotation in patients with non-bilious vomiting. Utilizing US can obviate the need for contrast examinations owing to its higher diagnostic accuracy and rapid diagnosis and can be recommended as a first-line imaging technique. Additionally, open surgery is still an option for neonatal patients.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 77%

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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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%

“…Sabac et al investigated a similar concept, seeking to establish a correlation between time from physician to surgeons assessment, and time from surgical review to surgical incision, with subsequent risk of bowel resection or pan‐necrosis. They too found no specific component of the process associated with delay 20 . Castle et al considered time delays depending on distance from referral centre to tertiary children's hospital but did not analyse these times with relation to morbidity 7 .…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Impact of Focused Abdominal Ultrasound Utilization on Outcomes for Children With Midgut Volvulus

Schiess,

Sammer,

Sher

et al. 2024

Journal of Pediatric Surgery

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Assessment of care timelines in intestinal malrotation with volvulus: A retrospective chart review

Cited by 3 publications

References 17 publications

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

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

Impact of Focused Abdominal Ultrasound Utilization on Outcomes for Children With Midgut Volvulus

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