Value of laparoscopy in children with a suspected rotation abnormality on imaging.

Abstract

BACKGROUND:

Although imaging is usually used for the diagnosis of rotation abnormalities, significant false-positive and false-negative rates have been reported. We studied the utility of laparoscopy in the management of children with a suspected rotation abnormality on imaging.

METHODS:

The charts of all children undergoing laparoscopy for a suspected intestinal rotation abnormality from January 2000 to August 2009 were retrospectively reviewed.

RESULTS:

There were 51 patients. Preoperative diagnosis based on upper gastrointestinal contrast study with or without contrast enema or ultrasound was malrotation without volvulus in 47%, malrotation with volvulus in 10%, and nonrotation in 6%; the other 37% had equivocal or inconclusive imaging studies. Of the patients who had a "definitive" preoperative diagnosis, 41% had a discrepant finding at laparoscopy. For those with inconclusive imaging studies, 32% were found on laparoscopy to have a narrow mesenteric base, which put them at significant risk of midgut volvulus.

CONCLUSION:

Imaging studies may be inaccurate in differentiating malrotation from nonrotation or normal rotation. Laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children without a narrow-based mesentery can undergo laparoscopy alone, and those with malrotation should undergo either laparoscopic or open Ladd procedure.

• Authors: Marvin Hsiao, Jacob C Langer
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 46 Issue 7 Pg. 1347-52 (Jul 2011) ISSN: 1531-5037 [Electronic] United States
• PMID: 21763833 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Barium Sulfate

Topics

• Barium Sulfate
• Bile
• Cerebral Palsy (epidemiology)
• Comorbidity
• Diagnostic Imaging
• Enema
• False Negative Reactions
• False Positive Reactions
• Heart Defects, Congenital (epidemiology)
• Humans
• Infant
• Infant, Newborn
• Intestinal Diseases (diagnosis, diagnostic imaging, surgery)
• Intestinal Volvulus (complications, diagnosis, surgery)
• Laparoscopy
• Laparotomy
• Length of Stay (statistics & numerical data)
• Mesentery (pathology)
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Tomography, X-Ray Computed
• Torsion Abnormality (diagnosis, diagnostic imaging, surgery)
• Ultrasonography
• Vomiting (etiology)