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By Alejandro PeƱarrieta Daher Pediatric Surgeon / Neonatal Surgeon
Paulette I Abbas, Heather A Dickerson, David E Wesson
BACKGROUND: There is disagreement over the management of malrotation in children with heterotaxy and congenital heart disease (CHD). We sought to evaluate the outcomes of management with a Ladd procedure compared to observation in this cohort of patients. METHODS: We performed a retrospective review of CHD children with heterotaxy and malrotation identified on radiographs treated from 8/2002 until 4/2014. Primary outcomes evaluated were readmission for small bowel obstruction (SBO) or volvulus...
May 2016: Journal of Pediatric Surgery
Melanie Drewett, Nav Johal, Charles Keys, Nigel J Hall, David Burge
PURPOSE: To determine the number of term infants with bilious vomiting (BV) referred to a neonatal surgical centre for exclusion of malrotation by upper gastrointestinal contrast (UGI) examination. METHODS: Retrospective review of term (>37/40) neonates <28 days of age undergoing UGI for exclusion of malrotation between Jan 2010 and Dec 2014 in a neonatal network with 30,000 term deliveries annually. Only infants with BV in the absence of alternative clinical/radiological diagnosis were included...
May 2016: Pediatric Surgery International
Nouredin Messaoudi, Koen Vanlede, Dirk Vervloessem, Marc Huyghe, Paul Leyman
Intestinal malrotation complicated by the development of midgut volvulus presents a difficult management dilemma because of the risk of short bowel syndrome. Here, we present our experience with a case of severe intestinal ischemia after derotation in a newborn successfully managed using systemic tissue plasminogen activator. The present report supports the usefulness of thrombolysis as a therapeutic option for reperfusion of ischemic small bowel due to midgut volvulus in neonates.
December 2015: European Journal of Pediatric Surgery Reports
Paul S Cullis, Sotirios Siminas, Paul D Losty
OBJECTIVE: (1) Is screening of intestinal rotational anatomy obligatory in "asymptomatic" patients with heterotaxy? (2) Does detection of an anomaly warrant surgical correction? SUMMARY OF BACKGROUND DATA: Heterotaxy is an abnormal arrangement of thoraco-abdominal viscera across a left-to-right axis. Intestinal rotational anomalies are frequent among patients with heterotaxy, but debate exists as to whether they are benign in nature, requiring careful observation alone, or if surgical correction is warranted to prevent obstruction or midgut volvulus...
December 2016: Annals of Surgery
Kathleen Graziano, Saleem Islam, Roshni Dasgupta, Monica E Lopez, Mary Austin, Li Ern Chen, Adam Goldin, Cynthia D Downard, Elizabeth Renaud, Fizan Abdullah
OBJECTIVE: Patients with malrotation, or an intestinal rotation abnormality (IRA), can experience serious adverse events. Increasingly, asymptomatic patients are being diagnosed with malrotation incidentally. Patients with symptomatic malrotation require surgery in an urgent or semiurgent manner to address their symptoms. The treatment of asymptomatic or incidentally discovered malrotation remains controversial. METHODS: Data were compiled from a broad search of Medline, Cochrane, Embase and Web of Science from January 1980 through January 2013 for five questions regarding asymptomatic malrotation...
October 2015: Journal of Pediatric Surgery
Go Miyano, Hiroaki Fukuzawa, Keiichi Morita, Masakatsu Kaneshiro, Hiromu Miyake, Hiroshi Nouso, Masaya Yamoto, Koji Fukumoto, Naoto Urushihara
AIM: To define the role of laparoscopy for treating malrotation in children. MATERIALS AND METHODS: The Ladd procedure (9 laparoscopic [lap-Ladd], 17 open [open-Ladd]; n=26) was performed in children up to and including 30 days of age (neonatal [Group N]) and older (Group C). These groups were compared retrospectively. RESULTS: Group N (n=14) comprised 3 lap-Ladd and 11 open-Ladd patients. Group C (n=12) comprised 6 lap-Ladd and 6 open-Ladd patients...
February 2015: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
E G Ford, M O Senac, M S Srikanth, J J Weitzman
Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7)...
February 1992: Annals of Surgery
Iain Hennessey, Rebecca John, Roger Gent, Day Way Goh
BACKGROUND: Intestinal malrotation and particularly volvulus are potentially devastating conditions. Upper gastrointestinal (UGI) contrast studies have been considered the gold standard for diagnosis. However the use of ultrasonography (US) has been increasingly described. We describe a method for delineating the duodenal anatomy with US as a means to exclude malrotation. OBJECTIVE: To report our experience using US to assess intestinal rotation. MATERIALS AND METHODS: We conducted a retrospective audit of US scans performed at a tertiary referral centre to exclude malrotation for paediatric surgery between 2008 and 2011...
April 2014: Pediatric Radiology
Feilim Liam Murphy, Anthony L Sparnon
BACKGROUND: It is accepted that children with volvulus require urgent surgery. However the long term sequelae and late complications of its surgical therapy are less well understood. We hypothesised that the surgical corrected intestinal malrotation have significant long term impact on the patients quality of life. METHODS: Forty-six children with intestinal malrotation were operated on at a tertiary referral centre over a fifteen year period. Their charts were retrospectively reviewed and the patients were contacted...
April 2006: Pediatric Surgery International
John Vassaur, Hannah Vassaur, F Paul Buckley
INTRODUCTION: The potential of single-incision laparoscopic surgery (SILS) as a less invasive and more cosmetically appealing technique has prompted the expansion of its adoption. SILS has been shown to be a safe and feasible alternative to traditional multiport cholecystectomy, appendectomy, colectomy, and many other laparoscopic procedures. The objective of this study is to provide an initial report of the feasibility of correcting intestinal malrotation via a single-incision laparoscopic transumbilical approach...
January 2014: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Edward M Kiely, Agostino Pierro, Christine Pierce, Kate Cross, Paolo De Coppi
Midgut volvulus due to malrotation may result in loss of the small bowel. Until now, after derotation of the volvulus, pediatric surgeons do not deal with the mesenteric thrombosis, which causes continuing ischemia of the intestine. On occasion, a "second look" laparotomy is performed in the hope that some improvement in blood supply to the intestine has occurred. We describe a new combined treatment to restore intestinal perfusion based on digital massage of the superior mesenteric vessels after derotation and systemic infusion of tissue-type plasminogen activator...
June 2012: Pediatrics
Deepika Nehra, Allan M Goldstein
BACKGROUND: The purpose of this study was to determine the incidence and clinical presentation of intestinal malrotation from infancy through adulthood by examining the experience of a single institution caring for patients of all ages with this condition. METHODS: We conducted a retrospective review on all patients diagnosed with intestinal malrotation at Massachusetts General Hospital between 1992 and 2009. Patient demographics, clinical history, diagnostic tests, operative procedures, and outcome variables were recorded...
March 2011: Surgery
Jeroen Hagendoorn, Daisy Vieira-Travassos, David van der Zee
BACKGROUND: Intestinal malrotation in neonates or infants may require urgent surgical treatment, especially when volvulus and vascular compromise of the midgut are suspected. Successful laparoscopic management of malrotation has been described in a number of case reports. It remains unclear, however, whether laparoscopy for the treatment of malrotation has a success rate equal to that of open surgery and what relative risks exist in terms of conversion and redo surgery in larger numbers of patients...
January 2011: Surgical Endoscopy
Yousef El-Gohary, Mohamed Alagtal, John Gillick
Intestinal malrotation associated with a volvulus requires immediate surgical intervention. The long-term sequelae of Ladd's procedure and its complications are not well defined. We designed this study to investigate the long-term complications following operative intervention for intestinal malrotation. Patients who have undergone a Ladd's procedure for malrotation from January 1999 till December 2008, from two tertiary centres, were identified using the Hospital Inpatient Enquiry system. Charts were analysed to obtain information about mode of presentation, method of diagnosis and postoperative outcomes...
February 2010: Pediatric Surgery International
Niyi Ade-Ajayi, Nigel J Hall, Ri Liesner, Edward M Kiely, Agostino Pierro, Derek J Roebuck, David P Drake
PURPOSE: We report our experience of the management of arterial occlusion in the newborn. METHODS: A case note review was carried out after ethical approval. Doppler ultrasonography confirmed the occlusion. Thrombolysis was the primary intervention. Surgery was used selectively. A good outcome was one without tissue loss or functional impairment or minimal tissue loss without functional impairment. Data are presented as medians with ranges. RESULTS: Ten patients (9 male; median gestational age, 35...
October 2008: Journal of Pediatric Surgery
Kimberly E Applegate, James M Anderson, Eugene C Klatte
Intestinal malrotation, which is defined by a congenital abnormal position of the duodenojejunal junction, may lead to midgut volvulus, a potentially life-threatening complication. An evaluation for malrotation is part of every upper gastrointestinal (GI) tract examination in pediatric patients, particularly neonates and infants. Although the diagnosis of malrotation is often straightforward, the imaging features in approximately 15% of upper GI tract examinations are equivocal and lead to a false-positive or false-negative interpretation...
September 2006: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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