Case report: Malrotation and midgut volvulus presenting as malabsorption

Jackson, Andrew B.; Bisset, R.; Dickson, A

doi:10.1016/s0009-9260(89)80280-6

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Moreover, gastric emptying disorders and intestinal malabsorption can be confused with food allergies. Both the mechanical problems and alterations of neurointestinal reflexes can explain the relationship between these symptoms and intestinal malrotation, especially if there are other digestive anomalies [28][29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

et al. 2007

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The malrotation and no well fixation anomalies of the digestive tract is also frequent in older child, young and adult, with characteristic and specific clinical presentation. Actually, the diagnostic and treatment seem to be late, after suffering prolonged symptoms and/or in emergency. We present nine cases of anomalies in the embryonic development of the digestive tract which were diagnosed and treated in infants or young, all above 2 years old. Eight cases were of more or less complete intestinal malrotation; one of them was a complete malrotation with an intrinsic duodenal stenosis associated (no bands of Ladd) and another one was a right paramesocolic hernia, always accompanied by malrotation. The association with other extra-digestive anomalies, especially urological, was 70%. The predominant symptom was intermittent abdominal pain (IAP)-80%-sometimes accompanied by vomiting (35%) and episodes of diarrhoea (25%). In all the cases, while the clinical background was early, diagnosis was late. Indeed, in 60% of the cases diagnosis was made intra-operatively in emergency surgical interventions. The imaging procedures employed were scanning and Doppler ultrasound, CT scan, and contrast gastrointestinal series (GIS). Up to 30% of errors in interpretation occurred, although they were eventually corrected with other tests. The most reliable diagnostic procedures were GIS and CT scan with contrast, although partial interpretation errors occurred with the latter procedure. Surgery was essential in 80% of the pre-operative cases, and in another two it was required as a preventative measure. Post-operatively, there was notable persistence of SBS in the cases of intestinal necrosis, and of other lesser symptoms in the rest. We conclude that: intestinal malrotations and malfixations are still being diagnosed very late, with serious systemic consequences such as intestinal obstructions or necroses, and prolonged clinical suffering. This could all be avoided if more attention were paid to the digestive symptoms associated with IAP, and to subocclusion or other abdominal phenomena (distension,...), together with, in the case of doubt about the findings with the previous procedures, the opportune imaging tests (e.g., abdominal Doppler ultrasound, CT scan with contrast, and barium GIS). Unlike other authors, we consider that the morbidity/mortality associated with cases of late diagnosis of these anomalies is high, and calls for earlier surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

et al. 2007

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“…Malabsorption pattern with diarrhea, protein calorie malnutrition and failure to thrive is also one of the rare presentation modes of MA after the neonatal period 1,3,5,6 . Among 82 patients with late presenting MA reported in the study of Spigland et al ., only three (3,6%) patients presented with this mode 2 .…”

Section: Discussionmentioning

confidence: 99%

Rare clinical presentation mode of intestinal malrotation after neonatal period: Malabsorption‐like symptoms due to chronic midgut volvulus

İmamoğlu

Çay²,

Sarıhan³

et al. 2004

Pediatrics International

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“…In general, older children have a longer course of vague antecedent symptoms such as intermittent, nonbilious vomiting and chronic abdominal pain [2,3] which might contribute to feeding difficulties and nutritional debility. The combination of feeding disorder, growth failure and unexplained protein-losing enteropathy should prompt the consideration of malrotation as a possible cause.…”

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confidence: 99%

Intestinal malrotation: an unusual presentation

El‐Matary

Jones

Wright

et al. 2003

European Journal of Pediatrics

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Intestinal malrotation is a common cause of upper gastro-intestinal obstruction and presents with duodenal obstruction caused by volvulus of the midgut loop [6]. Malrotation syndromes typically present during the first few months of life, but may sometimes present later, causing diagnostic difficulties [7]. We report an unusual presentation of malrotation.A 5-year-old boy initially presented, at the age of 18 months, with short history of anorexia, followed by nonbilious vomiting and fever, which was diagnosed as a non-specific viral infection with gastritis. Six months later, he presented with weight loss, occasional diarrhoea, vague recurrent abdominal pain but the most significant feature was his extremely poor appetite and suboptimal caloric intake. On both occasions, physical examination was unremarkable, but in view of his significant loss weight, he had a range of investigations including liver function tests, serum albumin level, coeliac disease screen, auto-antibody screen, immunoglobulin (Ig) profile, sweat test and urine and stool analyses. All investigations proved negative apart from an elevated C-reactive protein and the presence of fat globules in stool. Abdominal ultrasound and upper gastrointestinal endoscopy with biopsies were normal. Caloric supplements were prescribed.A few months later, he presented again with a similar picture. On physical examination, his abdomen was slightly distended without tenderness or rigidity and routine investigations showed a low lymphocyte count, hypoalbuminaemia (23 g/l), low serum IgG levels (total and subclasses), low but normal levels of the other immunoglobulins, raised faecal alpha-1-antitrypsin (9.75 mg/g stool, reference range 0.13-2.38 mg/g stool).He was recognised as having an unexplained proteinlosing enteropathy and, in view of poor caloric intake, was treated with nasogastric supplementary nutrition. However, he developed persistent diarrhoea and abdominal pain and was initially managed with total parenteral nutrition and subsequently with enteral elemental feed. Over the next 3 months, his nutritional state improved and his serum albumin returned to normal (41 g/l). Normal diet was introduced.At the age of 3 years he deteriorated again and was re-investigated. Colonoscopy revealed colonic inversus Fig. 1 A frontal view of the abdomen during barium meal followthrough examination shows a low-lying duodeno-jejunal junction and small bowel loops lying in the right flank consistent with malrotation Eur J Pediatr (2003) 162: 812-813

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Case report: Malrotation and midgut volvulus presenting as malabsorption

Cited by 7 publications

References 8 publications

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

Rare clinical presentation mode of intestinal malrotation after neonatal period: Malabsorption‐like symptoms due to chronic midgut volvulus

Intestinal malrotation: an unusual presentation

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