Surgical treatment of malrotation after infancy: a population-based study.
OBJECTIVE
Because malrotation most commonly presents in infants, treatment recommendations for older children (>1 year) have been based on data obtained from small case series. The purpose of this study was to use a large national database to determine the clinical significance of older children presenting with malrotation to develop treatment recommendations for this group.


METHODS
Records of children undergoing a Ladd's procedure were identified in the Kids' Inpatient Database, an administrative database that contains all pediatric discharges from 27 states during 2000. Patient characteristics, associated diagnoses, operations performed, and mortality were evaluated. Discharge weighting was used to obtain a national estimate of the number of children older than 1 year treated for malrotation.


RESULTS
Two hundred nineteen older children (>1 and <18 years) undergoing a Ladd's procedure were identified in the database. One hundred sixty-four (75%) of these patients were admitted for treatment of malrotation, whereas most of the remaining 55 patients (25%) were admitted for another diagnosis and underwent a Ladd's procedure incidental to another abdominal operation. Seventy-five patients underwent a Ladd's procedure during an emergency admission. Thirty-one patients had volvulus or intestinal ischemia, 7 underwent intestinal resection, and 1 patient died. Based on case weightings, it was estimated that 362 older children underwent a Ladd's procedure for symptoms related to malrotation in 2000 in the United States (5.3 cases per million population).


CONCLUSIONS
These findings provide support for performing a Ladd's procedure in older children with incidentally found malrotation to prevent the rare but potentially devastating complications of this anomaly.
Malek
Marcus M
MM
Department of Surgery, Division of Pediatric Surgery, Robert Wood Johnson Medical School, PO Box 19, New Brunswick, NJ 08903, USA.
Burd
Randall S
RS
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D019992:Databases as Topic; D004065:Digestive System Abnormalities / Q000150:complications / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D045822:Intestinal Volvulus / Q000209:etiology / Q000601:surgery*; D007422:Intestines / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery*; D007511:Ischemia; D008297:Male