Jack Barney Award. The changing spectrum of intestinal malrotation: diagnosis and management.

BACKGROUND: Management of typical malrotation is universally accepted, but management of atypical malrotation is less well defined in both children and adults.

METHODS: Records of patients with malrotation diagnosed over 6 years were reviewed. Patients were grouped into typical or atypical based on ligament of Treitz location. Outcomes were evaluated using chi-square analysis.

RESULTS: Of 275 patients, 148 diagnosed with typical malrotation underwent Ladd's procedure. Based on symptoms, 91 of 127 patients with atypical malrotation were managed operatively. The remaining 36 patients were asymptomatic or had reflux symptoms only and were observed. Six of 36 subsequently required surgery due to symptoms, but 30 remain asymptomatic. No observed patients developed acute midgut volvulus. The overall postoperative complication rates were higher for atypical versus typical malrotation, 27% versus 16% (P < .05).

CONCLUSIONS: Close observation with repeat contrast study is an acceptable management option for patients with atypical malrotation who are asymptomatic or exhibit only reflux symptoms.