Clinical Review of 10 Cases of Midgut Volvulus

중장 염전증의 임상적 고찰

Kang, Pil-Soo;Lee, Doo-Sun
강필수;이두선

  • Published : 20040000

Abstract

Purpose: The aims of this study were to mview the clinical characteristics of midgut volvulus and recognize the importance of the early diagnosis and treatment of midgut volvulus. Methods: The medical records of 10 patients with midgut volvulus, diagnosed at the Dankook University Hospital, between May 1995 and May 2001, were retrospectively reviewed. Results: There were 6 male and 4 female subjects. 80% of the patients were younger than 1 month old. The most common symptom was bilious vomiting. A simple abdominal X-ray was performed in 8 cases, with five of these 8 showing positive findings, such as a gasless abdomen or stomach dilatation. Ultrasonography was performed in all 10 cases. The sensitivity of the ultrasonography was 70%. UGI series was performed in 9 cases, and showed 100% sensitivity. Eight patients underwent surgical treatment. Seven infants in the early-diagnosis group had a Ladd operation performed, but only one patient whose diagnosis was delayed underwent a small bowel resection. The 7 patients that had undergone a Ladd operation showed good results after surgery. However, the one whose diagnosis had been delayed developed severe complications and mortality. Conclusion: The early diagnosis and adequate intervention for midgut volvulus can prevent life threatening complications. If the ultrasonographic findings are uncertain, especially when the midgut volvulus is untwisted after attack, UGI series or a barium enema should be performed to confirm the diagnosis.

Keywords

References

  1. Lin JN, Lou CC, Wang KL. Intestinal malrotation and midgut volvulus: a 15-year review. J Foermos Med Assoc 1995;94:178-81.
  2. Seashore JH, Touloukian RJ. Midgut volvulus. An ever-present threat. Arch Pediatr Adolesc Med 1994;148:43-6. https://doi.org/10.1001/archpedi.1994.02170010045009
  3. Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg 1993;17:326-31. https://doi.org/10.1007/BF01658699
  4. Stewart DR, Colodny AL, Daggett WC. Malrotation of the bowel in infants and children: a 15 year review. Surgery 1976;79:718-20.
  5. Andrassy RJ, Mahour GH. Malrotation of the midgut in infants and children. Arch Surg 1981;116:158-60. https://doi.org/10.1001/archsurg.1981.01380140020004
  6. Filston DM, Othersen HB, Smith CD. Malrotation of the intestine; the effect of age on presentation and therapy. J Pediatr Surg 1981;16:614-20. https://doi.org/10.1016/0022-3468(81)90015-4
  7. Spigland N, Brandt ML, Yaazzbeck S. Malrotation presenting beyond the neonatal period. J Pediatr Surg 1990;25:1139-42. https://doi.org/10.1016/0022-3468(90)90749-Y
  8. Coombs RC, Buick RG, Gornall PG, Corkey JJ, Booth IW. Intestinal malrotation. The role of small intestinal dysmotility in the cause of persistant symptoms. J Pediatr Surg 1991;26:553-6. https://doi.org/10.1016/0022-3468(91)90705-X
  9. Yanez R, Spitz l. Intestinal malrotation presenting outside the neonatal period. Arch Dis Child 1986;61:682-5. https://doi.org/10.1136/adc.61.7.682
  10. Messinea A, McMillan JH, Palder SB, Filler RM. Clinical factors affecting mortality in children with malrotation of intestine. J Pediatr Surg 1992;27:1343-5. https://doi.org/10.1016/0022-3468(92)90293-G
  11. Clark LA, Oldham KT. Malrotation In: Ashcraft KW, Murphy JP, Sharp RJ, Siaglet DL, Snyder CL, editors. Pediatric Surgery. 3rd ed. Phildelphia: WB Saunders 2000;425-34.
  12. Engum SA, Grosfeld JL. Malrotation & midgut volvulus. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery: Pediatric Surgery. 16th ed. Philadelphia: W.B. Saunders 2001;1477-88.
  13. Kim KW, Kim YC, Kim DY, Kim SC, Yoon CH, Kim IH. Clinical experience of midgut volvulus. J Kor Surg Soc 2002;63:333-6.
  14. Warner BW. Anomalies of intestinal rotation and fixation. In: Matti P, editor. Surgical directives pediatric surgery. 1st ed. Phildelphia: Lippincott Willams & Wilkins; 2003;P.289-91.
  15. Ai VHG, Lam WWM, Cheng W, Chan FL. CT appearance of midgut volvulus with malrotation in a young infant. J Clin Radiol 1999;54:687-98. https://doi.org/10.1016/S0009-9260(99)91092-9
  16. Dufour D, Deleat MH, Dassonville M. Midgut malrotaion, the reliability of sonographic diagnosis. Pediatr Radiol 1992;22:21-3. https://doi.org/10.1007/BF02011604
  17. Weinberger E, Winters WD, Liddell RM. Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery. Am J Roentgenol 1992;159:825-8. https://doi.org/10.2214/ajr.159.4.1529850
  18. Warner BW, Ziegler MM. Management of the short bowel syndrome in pediatric population. Pediatr Clin North Am 1993;40:1335-50. https://doi.org/10.1016/S0031-3955(16)38664-3
  19. Torres AM. Malrotation. In: Ziegler MM, Azizkhan RG, Weber TR, editors. Operative pediatric surgery. 1st ed. New York: McGraw Hill 2003;609-616.