Intestinal volvulus: Aetiology, morbidity and mortality in Tunisian children

Abstract

Background: Intestinal volvulus (IV) can occur at various sites of the gastrointestinal tract. In Europe, IV in children is most frequently due to malrotation but in Asia Ascaris infestation is a common cause. This report reviews the experience with IV in children in Tunisia; analyzes the aetiologies as well as the clinical presentations and the benefi ts of the Ladd’s procedure in the treatment of the IV. Patients and Methods: The authors retrospectively reviewed the case records of all children with IV from January 2000 to December 2009 at the Tunis Children’s Hospital. Results: There were 22 boys and nine girls with an age range of one day to four years. Twenty-fi ve (80%) patients presented during the neonatal period. The most common presentation was bilious vomiting and dehydration. The aetiology was identifi ed in all patients: Anomalies in rotation (n=22), omphalomesenteric duct (n=3), internal hernia (n=3), cystic lymphangioma (n=2), caocal volvulus (n=1). The bowel resection rate for gangrene was 16%. All patients with malrotation had Ladd’s procedure performed. Five patients (19%) developed wound infections. One patient presented with adhesive small bowel obstruction. There were no recurrences following Ladd’s procedure for malrotation. Two neonates (6%) died from overwhelming infections. Intestinal volvulus in our environment differs in aetiology from other reports. The resection rates are not similar, however. Conclusion: Early diagnosis reduced the high morbidity and mortality in our study.

Key words: Children, intestinal volvulus, malrotation, outcome