Anomalies of Midgut Rotation and Fixation Clinical Aspects Based on Sixty‐ Two Cases in Childhood

Abstract

Summary: The series reported here was collected at the Pediatric Surgery Department of Kronprinsessan Lovisas Barnsjukhus, Stockholm, during the period 1946–1960. It comprises 62 children ranging in age from newborn to 13 years. Five different stages of anomalies of rotation and fixation are described. The series is grouped accordingly and each group reported. The anomalies were almost twice as common in boys as in girls. Of the numerous concomitant malformations detected, omphalocele was most frequent, being present in 13 cases. In 29 cases the clinical symptoms were attributable to the anomalies of rotation and fixation; in the remainder the anomalies were incidental findings. The disease usually gave rise to symptoms in the neonatal period, 18 infants being hospitalized during the first few weeks of life. Of the various types observed, mixed rotation was the most common. The symptoms were produced by obstruction of the duodenum or by intestinal volvulus, these conditions giving rise to signs of high obstruction. The onset was generally acute in children less than one year of age but insidious in older children, whose disease assumed a chronic course, particularly when associated with intermittent volvulus. Vomiting and abdominal pain were the commonest symptoms, though in rare cases they were absent. In the infants less than one year of age suspected pylorospasm was the most frequent cause of delayed surgical intervention. Only in one case were vomiting and abdominal pain found to have been due to mobile cecum. This patient had a cecal volvulus. Diagnostically, barium enema was the examination of choice; barium meal examination yielded no definite information and was sometimes misleading. The prognosis was poor in the younger age groups and when coincident malformations or volvulus occurred. Eighteen patients died, all being under 4 months of age. There were 5 children without associated malformations who died: four of them had volvulus. Early diagnosis and early operation are of prognostic significance. When vomiting occurs in children, particularly during the neonatal period, plain radiograms of the abdomen plus barium enema examination should be performed in order to establish the correct diagnosis.