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Notable Clinical Differences Between Neonatal and Post-Neonatal Intestinal Malrotation: A Multicenter Review in Southern Japan.
Kedoin, Chihiro; Muto, Mitsuru; Nagano, Ayaka; Matsui, Mayu; Sugita, Koshiro; Baba, Tokuro; Miyoshi, Kina; Masuya, Ryuta; Murakami, Masakazu; Yano, Keisuke; Onishi, Shun; Harumatsu, Toshio; Yamada, Waka; Yamada, Koji; Matsukubo, Makoto; Kawano, Takafumi; Kuda, Masaaki; Nakame, Kazuhiko; Torikai, Motofumi; Ieiri, Satoshi.
Affiliation
  • Kedoin C; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Muto M; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan. Electronic address: mitsuru@m3.kufm.kagoshima-u.ac.jp.
  • Nagano A; Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.
  • Matsui M; Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.
  • Sugita K; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Baba T; Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
  • Miyoshi K; Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.
  • Masuya R; Division of the Gastrointestinal, Endocrine, and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
  • Murakami M; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Yano K; Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
  • Onishi S; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Harumatsu T; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Yamada W; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Yamada K; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Matsukubo M; Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.
  • Kawano T; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
  • Kuda M; Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
  • Nakame K; Division of the Gastrointestinal, Endocrine, and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
  • Torikai M; Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.
  • Ieiri S; Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
J Pediatr Surg ; 59(4): 566-570, 2024 Apr.
Article in En | MEDLINE | ID: mdl-38145920
ABSTRACT

BACKGROUND:

Most cases of intestinal malrotation appear in neonates with bilious vomiting due to midgut volvulus, whereas in cases that develop beyond infancy, the initial symptoms vary. This study investigated the clinical features of these two populations and identified issues that should be considered in daily practice.

METHODS:

A retrospective chart review was conducted from January 1, 2010, to December 31, 2022. Data on patients with intestinal malrotation were collected in an anonymized fashion from five pediatric surgical hub facilities in the Southern Kyushu and Okinawa areas of Japan.

RESULTS:

Of the 80 subjects, 57 (71.3%) were neonates (Group N) and 23 (28.7%) were infants and schoolchildren (Group I). The frequencies of initial symptoms, such as abdominal distention (Group N 19.3% vs. Group I 13.0%), bilious vomiting (59.6% vs. 43.5%), and hematochezia (8.8% vs. 21.7%), were not skewed by the age of onset (p = 0.535, 0.087, and 0.141, respectively). Midgut volvulus was significantly more frequent in Group N (71.9% [41/57] vs. 34.8% [8/23]; p = 0.005), while the degree of torsion was greater in group I (median 360° [interquartile range 180-360°] vs. 450° [360-540°]; p = 0.029). Although the bowel resection rate was equivalent (7.0% [4/57] vs. 4.3% [1/23]; p = 1.000), half of the patients in Group N presented with 180° torsion. The neonatal intestine has been highlighted as being more susceptible to ischemia than that in older children.

CONCLUSIONS:

The incidence of midgut volvulus is higher in neonates than in older children. Even relatively mild torsion can cause ischemic bowel changes during the neonatal period. LEVEL OF EVIDENCE LEVEL III.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Intestinal Volvulus / Digestive System Abnormalities Limits: Child / Humans / Infant / Newborn Country/Region as subject: Asia Language: En Journal: J Pediatr Surg Year: 2024 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Intestinal Volvulus / Digestive System Abnormalities Limits: Child / Humans / Infant / Newborn Country/Region as subject: Asia Language: En Journal: J Pediatr Surg Year: 2024 Document type: Article Affiliation country: Country of publication: