Twenty years' experience of midgut malrotation and volvulus in a tertiary center in northern Taiwan: A retrospective study

Wen-Yu Tseng; Ming-Wei Lai; Jin-Yao Lai; Chien-Chang Chen; Hsun-Chin Chao; Jeng-Chang Chen; Shih-Yen Chen; Yung-Ching Ming; Hung-Yu Yeh; Hung-Hsiang Lai; Sze-Ya Ting; Pai-Jui Yeh

doi:10.1016/j.pedneo.2023.11.009

Twenty years' experience of midgut malrotation and volvulus in a tertiary center in northern Taiwan: A retrospective study

Pediatr Neonatol. 2024 Apr 24:S1875-9572(24)00051-2. doi: 10.1016/j.pedneo.2023.11.009. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, Jen Ai Hospital, Dali Branch, No. 483, Dongrong Rd., Dali Dist., Taichung City, 412, Taiwan; Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
² Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan; College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan. Electronic address: a22141@cgmh.org.tw.
³ Department of Pediatric Surgery, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
⁴ Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan; College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan.
⁵ Department of Pediatrics, Ministry of Health and Welfare Shuang-Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan.
⁶ Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.

PMID: 38679520
DOI: 10.1016/j.pedneo.2023.11.009

Abstract

Background: Early diagnosis and surgical intervention for midgut malrotation with bowel obstruction are crucial. We aimed to identify risk factors for adverse outcomes in infants with midgut malrotation and to develop a prediction model.

Methods: We reviewed the operation records of infants surgically diagnosed with midgut malrotation at Chang Gung Children's Medical Center between January 2000 and December 2020. Patients were classified into the poor-outcome group (PO) if they underwent bowel resection or experienced mortality; all others were categorized as the favorable-outcome group (FO). Data on demographics, initial presentations, laboratory results, radiographic or sonographic findings, maternal conditions, and outcomes were collected and analyzed. Fisher's exact test, the independent sample t-test, and the Mann-Whitney test were utilized for comparative analysis when suitable.

Results: The study included 103 infants. Eleven were in the PO group, and 92 were in the FO group. Initial presentations such as respiratory distress, poor activity, and shock status were notably more prevalent in the PO group. The INR, hemoglobin, HCO₃, base excess, and aspartate transaminase values showed significant variation between the two groups. Multivariate analysis identified that lower hemoglobin (OR 0.677, p = 0.043) and higher AST (OR 1.036, p = 0.044) were independent predictors of adverse outcomes. An AST/Hb ratio of <3.78 demonstrated a high negative predictive value (98.6%) for an adverse outcome in midgut malrotation.

Conclusions: Prompt diagnosis and surgical treatment of midgut malrotation are vital to prevent bowel resection or mortality. The independent predicting factors for poor outcomes include low hemoglobin and elevated AST levels.

Keywords: Infant; Intestines excision; Upper gastrointestinal tract fluoroscopy; Volvulus of midgut.