Journal Title: پاييز 86
Article title: Evaluation of Diagnostic Challenges in Malrotation in 11 Patients with Late Presentations

Article PDF File:
Page From: 97 To: 104      
Article abstract:
Introduction & Objective: Intestinal malrotation is typically presented during the first few months of life but may sometimes appear later in life, causing difficulties and mistakes in diagnosis. The clinical diagnosis of malrotation is especially difficult in older children and adults because the presentation is usually nonspecific and the suspicion is rarely considered. In these cases diagnosis is often delayed. Materials & Methods: We reviewed records of patients with intestinal malrotation in Tehran Children’s Medical Center from 1983 to 2003. Records of 11 patients who were admitted after infancy and had undergone surgical procedure, which proved intestinal malrotation, were analyzed. Clinical and paraclinical data and surgical findings for each patient were collected. Frequent symptoms, duration of previous symptoms, associated anomalies, delay in diagnosis, previous wrong diagnoses, duration of admission time before surgery, surgical findings, complication and outcome were collected. Results: Frequent symptoms were bilious vomiting (100%), recurrent abdominal pain (54%) and constipation (45%). Other symptoms and clinical findings were dehydration, abdominal distention, fever, weight loss, obstipation and diarrhea. Five of eleven patients had had symptoms from neonatal period and median age of first presenting symptom was 30 days. The average interval between first symptoms and surgical correction of malrotation was about 22 months. Mean interval from admission to surgery was 7.3 day. Twenty two differential diagnoses had been considered for these patients and some of them had undergone false treatment. Contrast studies (upper gastrointestinal series and barium enema) diagnosed malrotation more accurately. None of our five patients that evaluated with ultrasonography were diagnosed by this modality. Conclusions: The diagnosis of intestinal malrotation should be considered in children and adult patient with signs and symptoms of small-bowel obstruction and chronic abdominal pain and in all similar patients with vague abdominal discomfort who do not respond to other therapies. Ultrasound examination can be a screening test but in centers with less experience, it is necessary to do contrast studies (including upper GI series and barium enema) to rule out malrotation in suspected patients.
Article KeyWords:
Midgut Malrotation, Intestinal Obstruction, Vague Abdominal Pain, Recurrent Abdominal Pain
Article Authors:

	دكتر هدايت‌اله نحـوي	First Author	Hnahvi@Sina.tums.ac.ir
	دكتر ژامك خورگامي	Other Author