Faculty Collaboration Database

The risk of volvulus in abdominal wall defects. J Pediatr Surg 2015 Apr;50(4):570-2

Date

04/04/2015

Pubmed ID

25840065

DOI

10.1016/j.jpedsurg.2014.12.017

Scopus ID

2-s2.0-84926222224 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

BACKGROUND: Congenital abdominal wall defects are associated with abnormal intestinal rotation and fixation. A Ladd's procedure is not routinely performed in these patients; it is believed intestinal fixation is provided by adhesions that develop post-repair of the defects. However, patients with omphalocele may not have adequately protective postoperative adhesions because of difference in the inflammatory state of the bowel wall and in repair strategy. The aim of this study is to describe the occurrence of midgut volvulus in patients with gastroschisis or omphalocele.

METHODS: A retrospective chart review was performed for all patients managed in a single institution born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy.

RESULTS: Of the 206 patients identified with abdominal wall defects, 142 patients (69%) had gastroschisis and 64 patients (31%) had omphalocele. Patients' follow up ranged from 4 years to 13 years. The median gestational age was 36 weeks (26-41 weeks) and the median birth weight was 2.42 kg (0.8-4.87 kg). None of the patients with gastroschisis developed midgut volvulus, however two patients (3%) with omphalocele developed midgut volvulus.

CONCLUSIONS: No patients with gastroschisis developed midgut volvulus. Therefore, the current practice of not routinely performing a Ladd's procedure is a safe approach during surgical repair of gastroschisis. The two cases of volvulus in patients with omphalocele may be related to less bowel fixation. It is necessary to examine current practice in regards to the need for assessing the risk of volvulus during omphalocele closure and counseling of these patients. This assessment may be achieved via routine examination of the width of the small bowel mesenteric base, whenever feasible; however, the sample size is relatively small to draw any definitive conclusions.

Author List

Abdelhafeez AH, Schultz JA, Ertl A, Cassidy LD, Wagner AJ

Authors

Laura Cassidy PhD Associate Dean, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Amy Wagner MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child
Child, Preschool
Digestive System Abnormalities
Female
Follow-Up Studies
Gastroschisis
Hernia, Umbilical
Herniorrhaphy
Humans
Infant
Infant, Newborn
Intestinal Volvulus
Male
Retrospective Studies
Risk Factors