Journal of Minimal Access Surgery

LETTER TO THE EDITOR
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Year : 2014  |  Volume : 10  |  Issue : 4  |  Page : 225-

Radiological versus clinical evidence of malrotation: Role of laparoscopy/laparotomy in Indian scenario

Shasanka Shekhar Panda1, Meely Panda2, Rashmi Ranjan Das3, Pankaj Kumar Mohanty4,  
1 Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Community Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
3 Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
4 Department of Neonatology, Manipal Hospital, Bengaluru, Karnataka, India

Correspondence Address:
Shasanka Shekhar Panda
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi
India




How to cite this article:
Panda SS, Panda M, Das RR, Mohanty PK. Radiological versus clinical evidence of malrotation: Role of laparoscopy/laparotomy in Indian scenario .J Min Access Surg 2014;10:225-225


How to cite this URL:
Panda SS, Panda M, Das RR, Mohanty PK. Radiological versus clinical evidence of malrotation: Role of laparoscopy/laparotomy in Indian scenario . J Min Access Surg [serial online] 2014 [cited 2021 Oct 16 ];10:225-225
Available from: https://www.journalofmas.com/text.asp?2014/10/4/225/141536


Full Text

Sir,

Malrotation can have varying levels of symptoms and signs and poses a significant diagnostic challenge. Bilious vomiting is always a concern because of its association with surgical aetiology. Bilious vomiting, in conjunction with abdominal pain, is considered to be a surgical problem, unless proved otherwise. In the neonatal period, this vomiting is due to high small bowel obstruction resulting from atresia, stenosis and malrotation, etc. In Indian children, besides tuberculosis, jejunal stricture due to nonspecific jejunoileitis was found to be an important cause of chronic high small bowel obstruction and bilious vomiting. [1]

Usually, the diagnosis of malrotation is made on imaging that is upper gastrointestinal (UGI) contrast study. In our institute, ultrasound is used as a diagnostic adjunct to aid decision making. Imaging studies may be inaccurate in differentiating malrotation from nonrotation or normal rotation. Laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children without a narrow-based mesentery can undergo laparoscopy alone, and those with malrotation should undergo either laparoscopic or open Ladd procedure. [2] In developing countries like India with limited resources, lack of adequate knowledge and poverty, delayed presentation is quite common. Atypical presentation can delay the diagnosis resulting in increased morbidity. As early features might not be typical of malrotation, a high index of suspicion is necessary to avoid morbidity. Hence in every case of radiological evidence of malrotation in children irrespective of signs and symptoms, we do laparotomy/laparoscopy depending on the patient condition.

Findings of UGI study and symptoms only decide the timing of surgery that is emergency or routine, but cannot postpone the surgery. UGI contrast study can occasionally be misleading. There is a significant rate of negative laparotomy following diagnosis of malrotation on UGI contrast study. [3] Therefore, all parents of patients undergoing laparotomy for malrotation should be informed of the risk of negative laparotomy as part of the consents process. Laparoscopy can be a good option in Indian children, where besides malrotation, tuberculosis and jejunal stricture due to nonspecific jejunoileitis was found to be an important cause of chronic high small bowel obstruction and bilious vomiting.

References

1Pandey A, Kumar V, Gangopadhyay AN, Sharma SP, Gopal SC, Gupta DK, et al. Chronic bilious vomiting in children in developing countries due to high bowel obstruction: Not always malrotation or tuberculosis. Pediatr Surg Int 2010;26:213-7.
2Hsiao M, Langer JC. Value of laparoscopy in children with a suspected rotation abnormality on imaging. J Pediatr Surg 2011;46:1347-52.
3Stephens LR, Donoghue V, Gillick J. Radiological versus clinical evidence of malrotation, a tortuous tale - 10-year review. Eur J Pediatr Surg 2012;22:238-42.