Pediatr Gastroenterol Hepatol Nutr.  2019 Sep;22(5):447-452. 10.5223/pghn.2019.22.5.447.

Is There a Need for Bowel Management after Surgery for Isolated Intestinal Malrotation in Children?

• Salö M

• KMID: 2457746
• DOI: http://doi.org/10.5223/pghn.2019.22.5.447

Abstract

PURPOSE
Few studies have reported non-acute long-term morbidity rates in children with intestinal malrotation. The aim of this study was to investigate the rate of constipation in children undergoing Ladd's procedure for isolated intestinal malrotation.
METHODS
This retrospective study included children aged <15 years who underwent Ladd's procedure for intestinal malrotation between 2001 and 2016. Demographics, presence of volvulus perioperatively, need for bowel resection, short term (<30 days) and long-term complications, including mortality were recorded. Constipation was defined as treatment with laxatives at 1-year follow-up.
RESULTS
Of the 43 children included in the study, 49% were boys. The median age at surgery was 28 days (0-5, 293 days). Volvulus occurred in 26 children (60.5%), and bowel resection was required in 4 children (9.3%). Short-term complications categorized as grades II-V according to the Clavien-Dindo classification occurred in 13 children (30.2%). Of these, 5 children (11.6%) required re-operation. Constipation was observed in 9 children (23.7%) at the 1-year follow-up. No difference was observed in the rate of perioperative volvulus between children with and without constipation (44% vs. 65%, p=0.45). Excluding re-operations performed within 30 days after surgery, 3 children (6%) underwent surgery for intestinal obstruction during the study period.
CONCLUSION
Many children undergoing Ladd's procedure require bowel management even at long-term follow-up, probably secondary to constipation. It is important to thoroughly evaluate bowel function at the time of follow-up to verify or exclude constipation, and if treatment of constipation is unsuccessful, these children require evaluation for dysmotility disorders and/or intestinal neuronal dysplasia.

Keyword

Intestinal malrotation; Outcome; Bowel management

MeSH Terms

Child*
Classification
Constipation
Demography
Follow-Up Studies
Humans
Intestinal Obstruction
Intestinal Volvulus
Laxatives
Mortality
Neurons
Retrospective Studies
Laxatives

Figure

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  Fig. 1 Age at symptom onset and surgery in 43 children who underwent Ladd's procedure for isolated intestinal malrotation.

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