PDF(Pubmed)
Abstract：
UNASSIGNED: Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in the neonatal period (75%) with sudden onset bilious vomiting and rarely beyond infancy (<10%).
UNASSIGNED: The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy.
UNASSIGNED: Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively.
UNASSIGNED: Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia.
UNASSIGNED: Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients.
UNASSIGNED: The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy.
UNASSIGNED: Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively.
UNASSIGNED: Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia.
UNASSIGNED: Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients.
摘要：
■肠旋转不良是胚胎发生过程中肠的异常或不完全旋转和固定引起的先天性异常。它通常在新生儿期（75％）出现突然发作的胆汁性呕吐，很少超过婴儿期（<10％）。
■这项研究的目的是突出临床特征，放射学发现，以及婴儿期以外的旋转不良患者的治疗结果。
■在5年（2017-2021年）内连续出现11例延迟出现旋转不良的病例。对数据进行回顾性分析。
■在11名患者中，四个是女性，七个是男性。患者年龄为14个月至18岁。婴儿期以外的患者通常表现为腹部弥漫性疼痛，而新生儿则表现为突然发作的胆汁性呕吐，因此难以诊断。五名患者患有相关异常，例如肠套叠或胡桃夹综合征或肠系膜囊肿或空肠狭窄或肠系膜淋巴结肿大以及旋转不良。患者接受了超声检查，上消化道造影研究，和腹部对比增强计算机断层扫描来确认诊断。所有患者均接受了Ladd手术，其中4例需要切除吻合，1例需要切除肠系膜囊肿。11名患者中有8名获得了良好的结果，两人发展为粘连性肠梗阻，需要重新探索，其中一人持续有便血的抱怨。
■婴儿期旋转不良是一种罕见的诊断。由于症状广泛，通常不会怀疑年龄较大的儿童的旋转不良。需要对超声或计算机断层扫描高度怀疑，以证明肠系膜上动脉和肠系膜上静脉位置的逆转以及相关状况。早期干预和治疗可以预防这些患者的灾难性事件，例如肠扭转和肠缺血。
■这项研究的目的是突出临床特征，放射学发现，以及婴儿期以外的旋转不良患者的治疗结果。
■在5年（2017-2021年）内连续出现11例延迟出现旋转不良的病例。对数据进行回顾性分析。
■在11名患者中，四个是女性，七个是男性。患者年龄为14个月至18岁。婴儿期以外的患者通常表现为腹部弥漫性疼痛，而新生儿则表现为突然发作的胆汁性呕吐，因此难以诊断。五名患者患有相关异常，例如肠套叠或胡桃夹综合征或肠系膜囊肿或空肠狭窄或肠系膜淋巴结肿大以及旋转不良。患者接受了超声检查，上消化道造影研究，和腹部对比增强计算机断层扫描来确认诊断。所有患者均接受了Ladd手术，其中4例需要切除吻合，1例需要切除肠系膜囊肿。11名患者中有8名获得了良好的结果，两人发展为粘连性肠梗阻，需要重新探索，其中一人持续有便血的抱怨。
■婴儿期旋转不良是一种罕见的诊断。由于症状广泛，通常不会怀疑年龄较大的儿童的旋转不良。需要对超声或计算机断层扫描高度怀疑，以证明肠系膜上动脉和肠系膜上静脉位置的逆转以及相关状况。早期干预和治疗可以预防这些患者的灾难性事件，例如肠扭转和肠缺血。
