Early versus delayed surgical correction of malrotation in children with critical congenital heart disease

Abstract

Purpose The purpose of this study was to compare outcomes between early and delayed surgical correction of malrotation in children with critical congenital heart disease (CHD). Methods Patients with CHD who underwent cardiac surgery by 1 year of age and had malrotation diagnosed during their initial admission at 34 hospitals contributing to the Pediatric Health Information System in 2004-2009 were included. Ladd's procedures performed during the first admission were considered early correction, and those at a subsequent admission were considered delayed. Inter-hospital variability in the proportion of patients undergoing delayed correction was assessed, and outcomes were compared between the groups. Results Of the 324 patients identified, 85.2% underwent early correction. Significant variability existed in the proportion of patients undergoing delayed correction across hospitals (p<0.0001). Baseline characteristics, including severity of CHD, were similar between the groups. In the delayed group, 27% of patients underwent a Ladd's procedure during an urgent or emergent admission, but none had volvulus or underwent intestinal resection. Rates of mortality and readmission within 1 year of malrotation diagnosis were similar in both groups. Chart validation confirmed 100% accuracy of diagnosis and treatment group assignment. Conclusions In patients with critical CHD, delayed operative intervention for malrotation without volvulus may be a reasonable alternative.

Evaluation of ultrasonography in fetal intestinal malrotation with midgut volvulus

“…Congenital intestinal malrotation with midgut volvulus can exist as a solitary malformation, but it is mostly associated with other malformations. Congenital intestinal malrotation has been highlighted as a component of multiple systemic malformations [13]. The incidence of intestinal malrotation combined with other malformations, such as the central nervous system, heart, and genitourinary system, has been reported to be 25-30% [14].…”

Apendicitis aguda en paciente adulto con rotación intestinal anormal y defecto cardiovascular: presentación de caso y revisión temática

“…Estas pueden convertirse en urgencias quirúrgicas y afectar gravemente el estado de salud del paciente con complicaciones fatales 12,[25][26][27][28] . Por otra parte, en nuestro medio se han llevado a cabo varios estudios comparando la apendicectomía abierta versus la realizada por laparoscopia, demostrando que esta última disminuye de manera significativa la morbilidad general, la tasa de infección del sitio operatorio (de 8.8 -10.3% con la técnica abierta vs. 1.1-2.8% con la laparoscópica), en especial la infección de la incisión del mismo y la presencia de abscesos intraabdominales, además de disminuir la estancia hospitalaria (a pesar de contar con mayor tiempo quirúrgico); por dichas razones es hoy en día el método estándar recomendado para el tratamiento de la apendicitis aguda [29][30][31] .…”

“…Esta asociación ocasiona retraso para el tratamiento quirúrgico en pacientes con rotación intestinal anormal detectados al nacimiento, por riesgo de aumentar la mortalidad. No obstante, no se han evidenciado diferencias significativas de mortalidad entre la práctica temprana y la tardía del procedimiento quirúrgico para corregir la rotación intestinal anormal en neonatos 28 . A pesar de la evidencia a favor de la corrección de la rotación intestinal anormal, en este caso solo se trató el cuadro agudo (apendicectomía) por decisión del cirujano, puesto que el paciente nunca había presentado síntomas asociados con su enfermedad de base.…”

Nonbilious Vomiting in a 4-Week-Old Male: A Case Report and Review of the Literature

“…8 Nevertheless, most surgeons agree that the benefits of a Ladd procedure to correct intestinal malrotation offsets the risks. 12 A Ladd procedure not only prevents the life-threatening complication of volvulus but also relieves other GI symptoms associated with malrotation. The lifetime risk of volvulus secondary to malrotation has been estimated to be up to 20%.…”