Midgut malrotation risk in abdominal wall defect

BACKGROUND: Midgut malrotation has a low incidence (0.5-1% at necropsies) and it is a rare symptomatic condition. Nevertheless it is often associated to clinical situations with a high morbility and mortality and it could complicate them. Our aim is to study the patients treated for abdominal wall defects and who have suffered complications due to non-treated malrotation at first surgery. METHODS: We retrospectively studied the charts of patients diagnosed of abdominal wall defects in our hospital from 1993 to 2002. We reviewed the initial treatment, the associated morbility and any new surgical treatment needed. RESULTS: During this 10-year period, 110 abdominal wall defects were managed: 56 congenital diaphragmatic hernias, 30 onphaloceles and 14 gastroschisis; overall 79 of these 100 patients survived and were included in this study. Eleven patients had symptoms due to bowel malrotation during the follow-up period. In 1 case the clinical picture had an acute onset as a volvulus that required extensive gut resection; another patient presented as a persistent gastrocutaneous fistula after removal of a gastrostomy tube; in the remaining 9, symptoms were always of classical intestinal obstruction. The malrotation was never treated during the initial surgical procedure for abdominal wall defect; later on, Ladd procedure was always the definitive treatment. CONCLUSIONS: Due to local conditions during first abdominal wall surgery that limit the evaluation of the malrotation, we must think about it when we find obstructive symptoms any time during life.