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  • Perinatal/Neonatal Case Presentation
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Perinatal/Neonatal Case Presentation

Intestinal malrotation in neonates with nonbilious emesis

Journal of Perinatology volume 26, pages 375–377 (2006)Cite this article

Abstract

Intestinal malrotation is a relatively uncommon condition with diverse outcomes. Familiarity with variations in the presentation of malrotation is imperative as early diagnosis and prompt subsequent surgical intervention are essential to optimizing outcome. The most frequent clinical sign in the neonate is bile-stained emesis. We report three cases of unsuspected malrotation that were diagnosed in neonates with a history of nonbilious emesis who were assessed for presumed gastroesophageal reflux or aspiration. Gastroesophageal reflux is a common condition among newborns, and can be a subtle presentation of malrotation. Clinicians should consider malrotation as a possible cause of reflux, particularly in infants with unusually pathologic or persistent symptoms necessitating ongoing treatment for reflux.

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References

  1. Millar AJW, Rode H, Brown RA, Cywes S . The deadly vomit: malrotation and midgut volvulus. Pediatr Surg Int 1987; 2: 172–176.

    Article  Google Scholar 

  2. Malcolm WF, Cotten CM for the NICHD Neonatal Research Network Anti-Reflux Medications (ARM) at NICU Discharge for Extremely Low Birth Weight (ELBW) Infants Society for Pediatric Research, 2006 Poster presentation.

  3. Filston HC, Kirks DR . Malrotation-the ubiquitous anomaly. J Pediatr Surg 1981; 16: 614–620.

    Article  CAS  Google Scholar 

  4. Yanez R, Spitz L . Intestinal malrotation presenting outside the neonatal period. Arch Dis Child 1986; 61 (7): 682–685.

    Article  CAS  Google Scholar 

  5. Cywes S, Millar AJW . Embryology and anomalies of the intestine. Bockus Gastroenterology, e5th edn. WB Saunders: Philadelphia, PA, 1995 pp 899–929.

    Google Scholar 

  6. Millar AJW, Rode H, Cywes S . Malrotation and volvulus in infancy and childhood. Sem Pediatr Surg 2003; 12 (4): 229–236.

    Article  CAS  Google Scholar 

  7. Godbole P, Stringer MD . Bilious vomiting in the newborn: how often is it pathologic? J Pediatr Surg 2002; 37: 909–911.

    Article  Google Scholar 

  8. Seashore JH, Touloukian RJ . Midgut volvulus. An ever-present threat. Arch Pediatr Adolesc Med 1994; 148 (1): 43–46.

    Article  CAS  Google Scholar 

  9. Simpson AJ, Leonidas JC, Krasma IH, Becker JM, Schneider KM . Roentgen diagnosis of midgut malrotation: value of upper gastrointestinal radiographic study. J Pediatr Surg 1972; 7: 243–252.

    Article  CAS  Google Scholar 

  10. Dufour D, Delaet MH, Dassonville M, Cadranel S, Perlmutter N . Midgut malrotation, the reliability of sonographic diagnosis. Pediatr Radiol 1992; 22: 21–23.

    Article  CAS  Google Scholar 

  11. Patino MO, Munden MM . Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. Ultrasound Med 2004; 23 (3): 397–401.

    Article  Google Scholar 

  12. Gross E, Chen MK, Lobe TE . Laparoscopic evaluation and treatment of intestinal malrotation in infants. Surf Endosc 1996; 10: 936–937.

    Article  CAS  Google Scholar 

  13. Demirbilek S, Karaman A, Gurunluoglu K, Akin M, Tas E, Aksoy RT et al. Delayed gastric emptying in gastroesophageal reflux disease: the role of malrotation. Pediatr Surg Int 2005; 21 (6): 423–427.

    Article  Google Scholar 

  14. Kumar D, Brereton RJ, Spitz L, Hall CM . Gastro-oesophageal reflux and intestinal malrotation in children. Br J Surg 1988; 75: 533–535.

    Article  CAS  Google Scholar 

  15. Aksglaede K, Pedersen JB, Lange A, Funch-Jensen P, Thommesen P . Gastro-esophageal reflux demonstrated by radiography in infants less than 1 year of age. Comparison with pH monitoring. Acta Radiol 2003; 44: 136–138.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon

    K El-Chammas

  2. Department of Pediatrics, Division of Neonatology, Duke University Medical Center, Durham, NC, USA

    W Malcolm & C M Cotten

  3. Department of Radiology, Duke University Medical Center, Durham, NC, USA

    A M Gaca

  4. East Carolina University, Greenville, NC, USA

    K Fieselman

Authors
  1. K El-Chammas
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  2. W Malcolm
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  3. A M Gaca
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  4. K Fieselman
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  5. C M Cotten
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Correspondence to C M Cotten.

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El-Chammas, K., Malcolm, W., Gaca, A. et al. Intestinal malrotation in neonates with nonbilious emesis. J Perinatol 26, 375–377 (2006). https://doi.org/10.1038/sj.jp.7211507

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  • DOI: https://doi.org/10.1038/sj.jp.7211507

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