Should malrotation in children be treated differently according to age?

Purpose: The aim of this study was to better define the mode of presentatio n, rate of volvulus, and surgical findings in children younger than 2 versu s older than 2 yea rs of age with malrotation. Methods: The authors reviewed the charts of all patients with malrotation a dmitted to their hospital between January 1980 and December 1998, excluding patients having malrotation as a secondary finding. Results: An upper gastrointestinal series was done in 90 patients (6% false ly negative) and a barium enema in 20 patients (40% read as normal). Fifty- eight patients had 114 associated congenital anomalies. Volvulus was found at the time of surgery in 28 patients, 5 of whom were older than 2 years. T hree presented with acute symptoms and 2 with chronic symptoms. Surgery was performed by laparotomy in 103 patients and by laparoscopy in 3. Mean leng th of stay was 13.6 days. Mean follow-up was 19 months. Death occurred in 4 patients; postoperative bowel obstruction was seen in 3 patients (only 1 r equired surgery). Conclusions: Children with malrotation who are older than 2 years old have a significant risk of volvulus that is difficult to predict radiologically. They require surgical attention even if asymptomatic. Laparoscopy allows e valuation of the base of the mesentery and completion of the Ladd's procedu re. Copyright (C) 2000 by W.B. Saunders Company.