What are the possible complications of intestinal malrotation?

Updated: Dec 19, 2018
  • Author: Denis D Bensard, MD, FACS, FAAP; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Complications include the following:

  • Short-bowel syndrome: Short-bowel syndrome is the most common complication of midgut volvulus. These patients have longer delays to recovery of bowel motility and function. They are at high risk for malabsorption and can require long-term parenteral nutrition. Furthermore, these patients have more complications from treatment and longer hospital stays than patients with malrotation without volvulus.

  • Infection: Wound infections and sepsis can occur in the immediate postoperative period, requiring extended treatment with intravenous antibiotics. Additionally, central venous catheters have the potential to become infected causing bacteremia and/or sepsis

  • Surgical complications: Postoperative and surgical complications are more likely to occur in those patients with acute symptoms than those with chronic symptoms. [14] One review reported an overall complication rate of 8.7% (14 of 161) following Ladd procedure. [52] Complications reported include adhesive small bowel obstruction in 6% with 5 requiring reoperation (3%), and 1 patient developed recurrent volvulus (1%). A second review showed comparable rates of recurrent volvulus (2%, 1 of 57) and reoperation for adhesive small bowel obstruction (2%, 1 of 57). [53] Other series have reported lower rates of recurrent volvulus, 0.4% in one series of 441 patients, and 0.6% in a series of 159 patients who underwent Ladd's procedure. [37]

  • Persistent GI symptoms: In the same series of 57 patients, 13 had persistent (>6 mo) GI symptoms, including constipation (6), intractable diarrhea (1), abdominal pain (2), vomiting (3), and feeding difficulties (1) following Ladd procedure. [53]

  • Mortality: Death occurs due to peritonitis, late nutritional complications, or catheter-related sepsis. Rates are increased among children younger than one year. Following Ladd procedure, mortality rates reported in the literature are as low as 2%. [52] However, if more than 75% of the bowel is necrotic, mortality is as high as 65%. [37]


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