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Intestinal malrotation in the older child: A call for vigilance

机译:大龄儿童肠部旋转不良:呼吁保持警惕

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Context: Most cases of gut malrotation are diagnosed in the 1st year of life, but in minority of cases, the patient becomes symptomatic only in adolescence or adulthood. Aims: The aim of this study was to remind physicians to include intestinal malrotation in the differential diagnosis of children who present with recurrent abdominal pain, especially when it is associated with vomiting and other gastrointestinal symptoms. Settings and Design: This was an audit of the older children with gut Malrotation who presented to the Lagos University Teaching Hospital (LUTH). Subjects and Methods: The clinical records of children above the age of 1 year who presented with recurrent abdominal pain and/or vomiting between January 2013 and October 2015 at the LUTH were reviewed. Clinical features, radiological findings, and operation findings were documented. Statistical Analysis: Data were analyzed using the SPSS version 21 (SPSS Statistics for Windows, version 21.0, IBM Corp., USA). Data were presented in frequency and percentages. Results: Five patients with gut malrotation were seen during the study period. The median age was 7.0 years (range: 15 months–10 years). The most common complaint was intermittent colicky abdominal pain and recurrent vomiting in 5 (100%). Preoperative diagnosis was possible in 3 patients, with the use of abdominal computerized tomography scan. Operative findings included obstructing bands of Ladd, volvulus with situs inversus. Symptoms were relieved satisfactorily with surgical intervention. Conclusions: There is a need for a high index of suspicion for intestinal malrotation in children who present with a prolonged history of recurrent abdominal pain and vomiting irrespective of the age. Imaging enables accurate diagnosis and most effective treatment is surgical.
机译:背景:大多数肠内旋转不良病例是在生命的第一年被诊断出的,但在少数情况下,该患者仅在青春期或成年后才出现症状。目的:本研究的目的是提醒医生,在出现反复腹痛的儿童(尤其是与呕吐和其他胃肠道症状相关的儿童)的鉴别诊断中,应包括肠道错误。设置和设计:这是对拉各斯大学教学医院(LUTH)出现的肠道畸形较大儿童的审计。研究对象和方法:回顾了2013年1月至2015年10月在LUTH出现腹部反复疼痛和/或呕吐的1岁以上儿童的临床记录。记录临床特征,放射学发现和手术发现。统计分析:使用SPSS 21版(Windows的SPSS Statistics,版本21.0,IBM Corp.,美国)分析数据。数据以频率和百分比表示。结果:在研究期间发现了5例肠蠕动患者。中位年龄为7.0岁(范围:15个月至10岁)。最常见的主诉是间歇性绞痛腹痛和反复呕吐者(5%)(100%)。使用腹部计算机断层扫描可以对3例患者进行术前诊断。手术结果包括阻塞Ladd带,扭转带和腹股沟。通过手术干预可令人满意地缓解症状。结论:对于存在反复发作的腹痛和呕吐病史的儿童,不论其年龄大小,都需要高度怀疑其肠蠕动。成像可以准确诊断,最有效的治疗方法是手术。

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