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Association of midgut malrotation with intussusception
Abstract
Background: The cause of intussusuception in most infants is unclear. Intestinal malrotation has been postulated as a possible cause in some infants. Waugh,s syndrome is the association of intestinal malrotation with intussusception.
Patients/Methods: Of 18 children with intussusception managed in the Paediatric Surgical Unit of our hospital over a 3-year period, eight had abnormality of intestinal rotation and fixation. Their case notes, operation notes and discharge summary sheets have been retrospectively reviewed.
Results: There were five boys and three girls. Their ages ranged from 13 days – 12 months (median 10 months). The main clinical features were bilious vomiting, blood stained diarrhoea and abdominal distension. In two infants, the intussusceptions had prolapsed through the anus at presentation. One neonate had ruptured omphalocoele minor containing a caeco-colic intussusception that had perforated at presentation. Two other infants had mid gut volvulus, one as a simultaneous finding with intussusception while the other one 72 hours after operative reduction of intussusception. All had laparotomy. In six infants, the intussusception was ileo-colic while in two it was caeco-colic. There was no lead point in any infant. Four infants had successful operative reduction while four had bowel resection with end-to-end anastomosis. All had Ladd's procedure. One child died of overwhelming sepsis following resection of gangrenous bowel.
Conclusion: Intestinal malrotation may be associated with idiopathic intussusception. It is important to look for this association when managing infants with intussusception.
Keywords: Waugh's syndrome, intussusception, malrotation, midgut volvulus, Ladd's procedure
Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 159-161
Patients/Methods: Of 18 children with intussusception managed in the Paediatric Surgical Unit of our hospital over a 3-year period, eight had abnormality of intestinal rotation and fixation. Their case notes, operation notes and discharge summary sheets have been retrospectively reviewed.
Results: There were five boys and three girls. Their ages ranged from 13 days – 12 months (median 10 months). The main clinical features were bilious vomiting, blood stained diarrhoea and abdominal distension. In two infants, the intussusceptions had prolapsed through the anus at presentation. One neonate had ruptured omphalocoele minor containing a caeco-colic intussusception that had perforated at presentation. Two other infants had mid gut volvulus, one as a simultaneous finding with intussusception while the other one 72 hours after operative reduction of intussusception. All had laparotomy. In six infants, the intussusception was ileo-colic while in two it was caeco-colic. There was no lead point in any infant. Four infants had successful operative reduction while four had bowel resection with end-to-end anastomosis. All had Ladd's procedure. One child died of overwhelming sepsis following resection of gangrenous bowel.
Conclusion: Intestinal malrotation may be associated with idiopathic intussusception. It is important to look for this association when managing infants with intussusception.
Keywords: Waugh's syndrome, intussusception, malrotation, midgut volvulus, Ladd's procedure
Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 159-161
