Pediatric Gastroenterology, Hepatology & Nutrition

  • 제22권5호
  • /
  • Pages.447-452
  • /
  • 2019
  • /
  • 2234-8646(pISSN)
  • /
  • 2234-8840(eISSN)
대한소아소화기영양학회 (The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition)
권호 표지
DOI QR코드

DOI QR Code

Is There a Need for Bowel Management after Surgery for Isolated Intestinal Malrotation in Children?

  • Salo, Martin (Department of Pediatric Surgery, Skane University Hospital)
  • 투고 : 2018.07.16
  • 심사 : 2019.02.06
  • 발행 : 2019.09.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Few studies have reported non-acute long-term morbidity rates in children with intestinal malrotation. The aim of this study was to investigate the rate of constipation in children undergoing Ladd's procedure for isolated intestinal malrotation. Methods: This retrospective study included children aged <15 years who underwent Ladd's procedure for intestinal malrotation between 2001 and 2016. Demographics, presence of volvulus perioperatively, need for bowel resection, short term (<30 days) and long-term complications, including mortality were recorded. Constipation was defined as treatment with laxatives at 1-year follow-up. Results: Of the 43 children included in the study, 49% were boys. The median age at surgery was 28 days (0-5, 293 days). Volvulus occurred in 26 children (60.5%), and bowel resection was required in 4 children (9.3%). Short-term complications categorized as grades II-V according to the Clavien-Dindo classification occurred in 13 children (30.2%). Of these, 5 children (11.6%) required re-operation. Constipation was observed in 9 children (23.7%) at the 1-year follow-up. No difference was observed in the rate of perioperative volvulus between children with and without constipation (44% vs. 65%, p=0.45). Excluding re-operations performed within 30 days after surgery, 3 children (6%) underwent surgery for intestinal obstruction during the study period. Conclusion: Many children undergoing Ladd's procedure require bowel management even at long-term follow-up, probably secondary to constipation. It is important to thoroughly evaluate bowel function at the time of follow-up to verify or exclude constipation, and if treatment of constipation is unsuccessful, these children require evaluation for dysmotility disorders and/or intestinal neuronal dysplasia.

키워드

참고문헌

  1. Dilley AV, Pereira J, Shi EC, Adams S, Kern IB, Currie B, et al. The radiologist says malrotation: does the surgeon operate? Pediatr Surg Int 2000;16:45-9. https://doi.org/10.1007/s003830050012
  2. Devane SP, Coombes R, Smith VV, Bisset WM, Booth IW, Lake BD, et al. Persistent gastrointestinal symptoms after correction of malrotation. Arch Dis Child 1992;67:218-21. https://doi.org/10.1136/adc.67.2.218
  3. Coombs RC, Buick RG, Gornall PG, Corkery JJ, Booth IW. Intestinal malrotation: the role of small intestinal dysmotility in the cause of persistent symptoms. J Pediatr Surg 1991;26:553-6. https://doi.org/10.1016/0022-3468(91)90705-X
  4. Feitz R, Vos A. Malrotation: the postoperative period. J Pediatr Surg 1997;32:1322-4. https://doi.org/10.1016/S0022-3468(97)90312-2
  5. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-96. https://doi.org/10.1097/SLA.0b013e3181b13ca2
  6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  7. Murphy FL, Sparnon AL. Long-term complications following intestinal malrotation and the Ladd's procedure: a 15 year review. Pediatr Surg Int 2006;22:326-9. https://doi.org/10.1007/s00383-006-1653-4
  8. Husberg B, Salehi K, Peters T, Gunnarsson U, Michanek M, Nordenskjold A, et al. Congenital intestinal malrotation in adolescent and adult patients: a 12-year clinical and radiological survey. Springerplus 2016;5:245. https://doi.org/10.1186/s40064-016-1842-0
  9. Van Den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006;101:2401-9. https://doi.org/10.1111/j.1572-0241.2006.00771.x
  10. Saps M, Nichols-Vinueza DX, Rosen JM, Velasco-Benitez CA. Prevalence of functional gastrointestinal disorders in Colombian school children. J Pediatr 2014;164:542-5.e1. https://doi.org/10.1016/j.jpeds.2013.10.088
  11. Loening-Baucke V. Prevalence rates for constipation and faecal and urinary incontinence. Arch Dis Child 2007;92:486-9. https://doi.org/10.1136/adc.2006.098335
  12. Kyrklund K, Koivusalo A, Rintala RJ, Pakarinen MP. Evaluation of bowel function and fecal continence in 594 Finnish individuals aged 4 to 26 years. Dis Colon Rectum 2012;55:671-6. https://doi.org/10.1097/DCR.0b013e31824c77e4
  13. Lindgren H, Nejstgaard MC, Salo M, Stenstrom P. Evaluation of bowel function in healthy children: untreated constipation is common. Acta Paediatr 2018;107:875-85. https://doi.org/10.1111/apa.14225
  14. Mehall JR, Chandler JC, Mehall RL, Jackson RJ, Wagner CW, Smith SD. Management of typical and atypical intestinal malrotation. J Pediatr Surg 2002;37:1169-72. https://doi.org/10.1053/jpsu.2002.34465
  15. Stauffer UG, Herrmann P. Comparison of late results in patients with corrected intestinal malrotation with and without fixation of the mesentery. J Pediatr Surg 1980;15:9-12. https://doi.org/10.1016/S0022-3468(80)80393-9
  16. Martucciello G, Torre M, Pini Prato A, Lerone M, Campus R, Leggio S, et al. Associated anomalies in intestinal neuronal dysplasia. J Pediatr Surg 2002;37:219-23. https://doi.org/10.1053/jpsu.2002.30258
  17. El-Gohary Y, Alagtal M, Gillick J. Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int 2010;26:203-6. https://doi.org/10.1007/s00383-009-2483-y