Abstract：
BACKGROUND: Malrotation and volvulus classically present with bilious vomiting. It is more common earlier in life, but there are other causes of bile-stained vomiting. This leads some clinicians to \'watch and wait\'. In the presence of a volvulus, this is potentially a fatal decision. It is not clear from the literature if there is a safe time window in which children can be observed in the hope of avoiding transfers or radiological investigations.
OBJECTIVE: To determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care.
METHODS: Multicentre, retrospective review of all children with malrotation ± volvulus at two tertiary children\'s hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re-operations and death.
RESULTS: There were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile-stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post-operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re-operation.
CONCLUSIONS: Malrotation remains a time-critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for \'watch and wait\' for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.
OBJECTIVE: To determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care.
METHODS: Multicentre, retrospective review of all children with malrotation ± volvulus at two tertiary children\'s hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re-operations and death.
RESULTS: There were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile-stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post-operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re-operation.
CONCLUSIONS: Malrotation remains a time-critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for \'watch and wait\' for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.
摘要：
背景：旋转不良和肠扭转通常表现为胆汁性呕吐。这在早期生活中更常见，但是胆汁染色呕吐还有其他原因。这导致一些临床医生“观察并等待”。在有扭转的情况下，这可能是一个致命的决定。从文献中还不清楚是否有一个安全的时间窗口可以观察儿童，以避免转移或放射学检查。
目的：确定识别和治疗中肠扭转的时间是否与发病率和死亡率相关；以及是否存在过渡护理模式。
方法：多中心，从2000年到2012年，对布里斯班两家三级儿童医院的所有旋转不良±扭转儿童进行了回顾性分析。收集的数据包括演示时的年龄，症状发作和表现之间的时间，放射学发现，和明确的手术管理。结果包括患者住院时间（LOS），全胃肠外营养（TPN）持续时间，重新手术和死亡。
结果：发现旋转不良96例，排除23人(选择性手术，数据不足)。新生儿占纳入病例的66%。只有14%的病例超过12个月。71％（52）的症状是胆汁性呕吐或胆汁染色的抽吸物。总死亡率为5.56%。从症状出现到出现或治疗的时间与发病率或死亡率无显著相关。超过一半（53%，39/73）的患者接受了全胃肠外营养；20/39超过10天。与年龄较大的儿童相比，新生儿和婴儿的TPN发生率明显更高（P<0.001）。术后需要TPN的患者死亡率明显高于不需要TPN的患者（P=0.02）。从症状发作到出现或确定治疗的时间与LOS无显著相关，TPN持续时间,或需要重新操作。
结论：旋转不良仍然是确保和治疗的时间关键的诊断。即使短时间的症状也可能与高发病率或死亡率相关。这样的病人没有‘观察和等待’的地方，和旋转不良/扭转应紧急积极排除对比研究。
目的：确定识别和治疗中肠扭转的时间是否与发病率和死亡率相关；以及是否存在过渡护理模式。
方法：多中心，从2000年到2012年，对布里斯班两家三级儿童医院的所有旋转不良±扭转儿童进行了回顾性分析。收集的数据包括演示时的年龄，症状发作和表现之间的时间，放射学发现，和明确的手术管理。结果包括患者住院时间（LOS），全胃肠外营养（TPN）持续时间，重新手术和死亡。
结果：发现旋转不良96例，排除23人(选择性手术，数据不足)。新生儿占纳入病例的66%。只有14%的病例超过12个月。71％（52）的症状是胆汁性呕吐或胆汁染色的抽吸物。总死亡率为5.56%。从症状出现到出现或治疗的时间与发病率或死亡率无显著相关。超过一半（53%，39/73）的患者接受了全胃肠外营养；20/39超过10天。与年龄较大的儿童相比，新生儿和婴儿的TPN发生率明显更高（P<0.001）。术后需要TPN的患者死亡率明显高于不需要TPN的患者（P=0.02）。从症状发作到出现或确定治疗的时间与LOS无显著相关，TPN持续时间,或需要重新操作。
结论：旋转不良仍然是确保和治疗的时间关键的诊断。即使短时间的症状也可能与高发病率或死亡率相关。这样的病人没有‘观察和等待’的地方，和旋转不良/扭转应紧急积极排除对比研究。
