Abstract

Objective: To emphasize difficulties in the diagnosis of intestinal rotation anomalies and choice of diagnostic techniques.

Material and Methods: Patients with operative diagnosis of malrotation and fixation anomalies between January 2000-December 2010 were studied retrospectively. Diagnostic methods, preoperative and operative diagnosis, surgical techniques, additional anomalies observed and complications were noted.

Results: A total of 25 patients, 13 males and 12 females aged between 1 day and 5.5 years (mean age 28 days) were evaluated. 19 patients were operated with diagnosis of intestinal (10 patients) or duodenal (6 patients) atresia and congenital diaphragmatic hernia (3 patients) established after plain erect xrays. There was intestinal atresia with malrotation in only 4 of 10 patients with diagnosis of intestinal atresia and only malrotation in the remaining 6 patients (one of them had midgut volvulus). Of the six patients operated due to duodenal atresia, duodenal atresia and malrotation were found in 3 and only duodenal atresia in 3 patients. On the other hand, there was malrotation in patients with omphalocele (1) and congenital megacolon (1) during the operation. In only 4 patients (16 %), true diagnosis of malrotation was possible with baryum enema and serial xrays with oral contrast. Incision of Ladd’s bands was made to remove obstruction due to malrotation and appendectomy (8 patients) and fixation of caecum (3 patients) were added to this procedure. One patient died due to sepsis and one patient who was operated for midgut volvus died from short bowel syndrome.

Conclusion: It is believed that the most useful diagnostic method for malrotation is to establish the caecal position by baryum enema and serial xrays with oral contrast.