Highlights
- •Malrotation and nonfixation are associated with increased small bowel obstruction (SBO).
- •Normal rotation is not fully protective from volvulus.
- •Malrotation without LADD procedure may increase risk for SBO including volvulus.
- •Bowel rotation and fixation should be evaluated during initial surgery, routinely documented and used for family counseling.
Abstract
Aim of the study
Small bowel obstruction (SBO) is a known complication after congenital diaphragmatic
hernia (CDH) repair, which can require surgery and even extensive bowel resection
causing short bowel syndrome (SBS). We investigate whether specific bowel rotation
and fixation can be used as a predictor for SBO including volvulus.
Methods
A retrospective review of 256 CDH survivors following repair from 2003 to 2020 was
performed. Operative notes and upper gastrointestinal series (UGI) were screened to
determine the rotation and fixation of the bowel. Primary outcomes included SBO occurrence,
SBO treated surgically, and volvulus. For statistical analysis Fisher's exact test
was utilized.
Results
Twenty-two (9%) patients presented with SBO and majority, 19 (86%), required surgery.
Adhesion were observed in 10 (45%), recurrence in 5 (23%), and extensive volvulus
leading to SBS in 3 (14%). Both rotation and fixation were recorded in 117 (46%).
Presence of left CDH with malrotation and nonfixation was a significant predictor
for SBO requiring surgery (P<0.05 vs all other groups). All 3 patients with extensive volvulus had left CDH with
nonfixed bowel (100%), however only 1 had malrotation (33%).
Conclusions
Malrotation and nonfixation are associated with increased SBO in CDH. Normal rotation
is not protective and patients are still at risk for volvulus resulting in SBS. SBO
requiring surgical intervention is common in CDH. Bowel rotation and fixation are
important determinants that, should be routinely documented and education about the
risk of SBO should be included in family counseling.
Level of Evidence
Level IV – Case Series
Keywords
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References
- The congenital diaphragmatic hernia study group registry update.Semin Fetal Neonatal Med. 2014; 19: 370-375
- Long-term maturation of congenital diaphragmatic hernia treatment results toward development of a severity-specific treatment algorithm.Ann Surg. 2013; 258: 638-646
- Congenital diaphragmatic hernia defect size and infant morbidity at discharge.Pediatrics. 2016; 138e20162043
- Multi-institutional follow-up of patients with congenital diaphragmatic hernia reveals severe disability and variations in practice.J Pediatr Surg. 2012; 47: 836-841
- Perinatal management and outcome of prenatally diagnosed congenital diaphragmatic hernia: a 1995–2000 series in Rennes University Hospital.Prenat Diagn. 2002; 22: 988-994
- Late surgical outcomes among congenital diaphragmatic hernia (CDH) patients: why long-term follow-up with surgeons is recommended.J Pediatr Surg. 2013; 48: 935-941
- Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia.Pediatrics (Evanston). 2005; 116: 356-363
- Long-term follow up of infants with congenital diaphragmatic hernia.Semin Pediatr Surg. 2007; 16: 134-144
- Intestinal rehabilitation and bowel reconstructive surgery: improved outcomes in children with short bowel syndrome.J Pediatr Gastroenterol Nutr. 2012; 54: 505-509
- Intestinal rotation in experimental congenital diaphragmatic hernia.J Pediatr Surg. 1995; 30: 1457-1462
- Malrotation in congenital diaphragmatic hernia: is it really a problem?.Eur J Pediatr Surg. 2020; 30: 434-439
- An adult presentation of midgut volvulus secondary to intestinal malrotation: a case report and literature review.Int J Surg Case Rep. 2018; 50: 46-49
- Diagnostic performance of the upper gastrointestinal series in the evaluation of children with clinically suspected malrotation.Pediatr Radiol. 2008; 38: 518-528
- Standardized reporting for congenital diaphragmatic hernia – an international consensus.J Pediat Surg. 2013; 48: 2408-2415
- Evidence-based diagnosis of malrotation and volvulus.Pediatr Radiol. 2009; 39: 161-163
- Midgut malfixation in patients with congenital diaphragmatic hernia: what is the risk of midgut volvulus?.Pediatr Radiol. 1995; 25: 259-261
- Risk-stratification enables accurate single-center outcomes assessment in congenital diaphragmatic hernia (CDH).J Pediatr Surg. 2019; 54: 932-936
- Factors related to long-term surgical morbidity in congenital diaphragmatic hernia survivors.J Pediatr Surg. 2018; 53: 508-512
- Abdominal complications related to type of repair for congenital diaphragmatic hernia.J Surg Res. 2007; 140: 234-236
- Minimally invasive vs open congenital diaphragmatic hernia repair: is there a superior approach?.J Am Coll Surg. 2017; 224: 416-422
- International survey on the management of congenital diaphragmatic hernia.Eur J Pediatr Surg. 2016; 26: 38-46
- Asymptomatic malrotation: diagnosis and surgical management an American pediatric surgical association outcomes and evidence based practice committee systematic review.J Pediatr Surg. 2015; 0: 1783-1790
Article info
Publication history
Published online: October 21, 2022
Accepted:
October 11,
2022
Received:
October 5,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
