The risk of midgut volvulus in patients with abdominal wall defects: A multi-institutional study

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• 作者：Jason A. Fawley^a ; ^b ; Abdelhafeez H. Abdelhafeez^c ; Jessica A. Schultz^a ; ^b ; Allison Ertl^a ; Laura D. Cassidy^a ; ^b ; Shawn St. Peter^d ; Amy J. Wagner^a ; ^b ; ^{AWagner@chw.org}
• 关键词：Midgut volvulus ; Omphalocele ; Gastroschisis ; Ladd procedure
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：1
• 页码：26-29
• 全文大小：176 K
• 卷排序：52

文摘

The management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure.MethodsA retrospective chart review was performed for all patients managed at three institutions born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy.ResultsOf the 414 patients identified with abdominal wall defects, 299 patients (72%) had gastroschisis, and 115 patients (28%) had omphalocele. The mean gestational age at birth was 36.1 ± 2.3 weeks, and the mean birth weight was 2.57 ± 0.7 kg. There were a total of 8 (1.9%) cases of midgut volvulus: 3 (1.0%) patients with gastroschisis compared to 5 patients (4.4%) with omphalocele (p = 0.04).ConclusionsPatients with omphalocele have a greater risk of developing midgut volvulus, and a Ladd procedure should be considered during definitive repair to mitigate these risks.Level of evidenceIII; retrospective comparative study