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Principles of paediatric surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Intestinal malrotation. By the 12th week of gestation, the midgut has returned to the fetal abdomen from the extraembryonic coelom and has begun rotating counterclockwise around the superior mesenteric artery axis. In classical intestinal malrotation, this process fails; the duodenojejunal flexure lies to the right of the midline and the caecum is central, creating a narrow base for the small bowel mesentery, which predisposes to midgut volvulus (Figure9.27). Malrotation with volvulus is life-threatening and typically presents with bilious vomiting. Bile-stained vomiting in the infant is a sign of intestinal obstruction until proved otherwise.
The large intestine
Published in Paul Ong, Rachel Skittrall, Gastrointestinal Nursing, 2017
Intestinal malrotation is a birth defect involving a malformation of the intestinal tract (Pickhardt and Bhalla 2002; Gamblin et al., 2003). During embryonic development the digestive tract starts as a straight tube and after 10 weeks’ gestation the tube makes two rotations. Intestinal malrotation occurs when the tube does not make these turns (Figure 7.10a). This birth defect presents in a broad range of clinical manifestations based on different anatomical configurations ranging from abnormal intestinal position, to complete nonrotation, to reverse rotation (Kapfer and Rappold, 2004). Neonates will present with bilious vomiting, bloody stools and failure to thrive. Infants present with recurrent abdominal pain, intestinal obstruction, malabsorption, vomiting, common bile duct obstruction, abdominal distension and failure to thrive. Intestinal malrotation can lead to volvulus (twisted intestine) (Figure 7.10b) causing intestinal obstruction and in severe cases intestinal ischaemia and necrosis as the blood supply is interrupted. In adults in the extreme manifestation of intestinal malrotation, that is, with an associated volvulus, patients may present with a high-grade bowel obstruction and intestinal ischaemia (Palepu et al., 2007).
Intestinal malrotation
Published in Prem Puri, Newborn Surgery, 2017
Intestinal malrotation results from an arrest of normal rotation of the embryonic gut. The intestine develops in utero through three stages that occur during the first trimester. During the first stage (5th to 10th weeks), the elongating bowel exceeds the abdominal cavity and herniates outside the abdomen. During the second stage (10th to 11th weeks), the bowel returns into the abdomen and rotates 270° counterclockwise around the superior mesenteric artery. The third stage (12th week) is characterized by the retroperitoneal fixation of the duodenum and colon. The distal duodenum comes to lie across the midline toward the left upper quadrant, attached by the ligament of Treitz at the DJ flexure to the posterior abdominal wall. The cecum passes to the right and downward and becomes fixed to the posterior abdominal wall.
Primary midgut volvulus without intestinal malrotation in a young adult: a case report
Published in Acta Chirurgica Belgica, 2020
Nicolas De Hous, Charles de Gheldere, Rodrigo Salgado, Filip Gryspeerdt
Midgut volvulus usually occurs in the setting of intestinal malrotation [3]. The normal embryological bowel rotation, in which the duodenojejunal and ileocolic junction rotate around the superior mesenteric artery to their normal position, fails to occur [2]. As a result, the small intestine is not secured to the abdominal cavity by the mesentery and suspended on a narrow mesenteric stalk, predisposing to twisting and midgut volvulus [3]. The pathophysiology of midgut volvulus without intestinal malrotation is unknown. Possible predisposing factors include a relative narrow mesenteric base, a longer mesentery, a lack of mesenteric fat or incomplete fixation to the posterior abdominal wall [4,5].
Lipid Apheresis to Manage Severe Hypertriglyceridemia during Induction Therapy in a Child with Acute Lymphoblastic Leukemia
Published in Pediatric Hematology and Oncology, 2020
Christina Mayerhofer, Carsten Speckmann, Friedrich Kapp, Ulrike Teufel-Schäfer, Wolfram Kluwe, Johanna Schneider, Christian Flotho
During subsequent leukemia therapy, which was continued without modifications to glucocorticoid or PEG-asparaginase schedules, the patient repeatedly complained of abdominal pain. On day 15 of reintensification (protocol II), the condition intensified to the degree of acute abdomen. The abdominal MRI suggested an intestinal malrotation with signs of volvulus (venous congestion, truncated mesenteric superior vein). The emergency surgery did not confirm any intestinal malrotation but revealed a coecum mobile that was fixed in the same procedure. The chemotherapy was paused for three weeks and resumed without further complications. No further episodes of hypertriglyceridemia were observed.
Massive ascites and severe pulmonary hypoplasia in a premature infant with meconium peritonitis and congenital cytomegalovirus infection
Published in Fetal and Pediatric Pathology, 2020
During normal fetal development, the gastrointestinal tract herniates out of the abdominal cavity, undergoes a 270° counterclockwise rotation around the superior mesenteric artery, and returns to the abdominal cavity. The duodenojejunal loop is then fixed to the left of the midline and the cecum to the right lower quadrant. If this process is interrupted at any point during fetal development, the result is known as intestinal malrotation, which can lead to a range of gastrointestinal abnormalities, the most common of which being midgut volvulus.