Intestinal malrotation in the older child: A call for vigilance
Context: Most cases of gut malrotation are diagnosed in the 1st year of life, but in minority of cases, the patient becomes symptomatic only in adolescence or adulthood. Aims: The aim of this study was to remind physicians to include intestinal malrotation in the differential diagnosis of children who present with recurrent abdominal pain, especially when it is associated with vomiting and other gastrointestinal symptoms. Settings and Design: This was an audit of the older children with gut Malrotation who presented to the Lagos University Teaching Hospital(LUTH). Subjects and Methods: The clinical records of children above the age of 1 year who presented with recurrent abdominal pain and/or vomiting between January 2013 and October 2015 at the LUTH were reviewed. Clinical features, radiological findings, and operation findings were documented. Statistical Analysis: Data were analyzed using the SPSS version 21 (SPSS Statistics for Windows, version 21.0, IBM Corp., USA). Data were presented in frequency and percentages. Results: Five patients with gut malrotation were seen during the study period. The median age was 7.0 years (range: 15 months–10 years). The most common complaint was intermittent colicky abdominal pain and recurrent vomiting in 5 (100%). Preoperative diagnosis was possible in 3 patients, with the use of abdominal computerized tomography scan. Operative findings included obstructing bands of Ladd, volvulus with situs inversus. Symptoms were relieved satisfactorily with surgical intervention. Conclusions: There is a need for a high index of suspicion for intestinal malrotation in children who present with a prolonged history of recurrent abdominal pain and vomiting irrespective of the age. Imaging enables accurate diagnosis and most effective treatment is surgical.