title: Early prediction of complex midgut volvulus in neonates and infants.
abstract: BACKGROUND
  Prognosis of midgut volvulus in neonates and infants younger than 1 year remains poor, as diagnostic findings may not be apparent until gut infarction had occurred. To characterize factors that help to predict complex midgut volvulus early was aim of this study.
  
  
  METHODS
  Institutionally approved retrospective analysis of all children younger than 1 year treated for midgut volvulus at the author's center from January 2002 to December 2011. Medical history, symptoms, laboratory and radiologic findings as well as sequelae of midgut volvulus were evaluated.
  
  
  RESULTS
  In 10 years, 37 children fulfilled the inclusion criteria. Of these, 43% developed complications, and mortality rate was 16%. In 30% of the patients, the only clinical sign was a sudden worsening of the general condition and abdominal distension (complex 19% vs. simple 38%). In one child with simple midgut volvulus, all clinical, laboratory and radiologic signs were negative. CART analysis identified a base excess below -1.70 and preterm birth (<36 weeks) as the best discriminators of complex and simple midgut volvulus. A score >1pt (comprised of these two factors) was found in all children with complex and in 14% of simple midgut volvulus (p < 0.001). A positive score (>1pt) offers a sensitivity of 100% (81.7-100%), specificity of 85.7% (71.8-85.7%), a PPV of 84.2% (68.8-84.2%) and NPV 100% (83.8-100%).
  
  
  CONCLUSIONS
  The study shows that midgut volvulus has a substantial morbidity and mortality. Unfortunately, not all affected children get picked up by history, laboratory and imaging. However, the proposed score helps to identify subject with increased risk of complications. It has the potential to facilitate and accelerate diagnosis of complex midgut volvulus; ultimately, it might help to reduce morbidity and mortality.
authors.affiliation: Department of Pediatric Surgery, University Hospital Hamburg-Eppendorf and Altona Children's Hospital, Martinistrasse 54, 20246, Hamburg, Germany.
authors.forename: Ilias
authors.initials: I
authors.lastname: Kanellos-Becker
authors.forename: Robert
authors.initials: R
authors.lastname: Bergholz
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinshagen
authors.forename: Michael
authors.initials: M
authors.lastname: Boettcher
mesh_terms: D003952:Diagnostic Imaging; D004065:Digestive System Abnormalities / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
references.citation: J Pediatr Gastroenterol Nutr. 2011 Oct;53(4):417-22
references.pmid: 21519283
references.citation: Pediatr Radiol. 2008 May;38(5):518-28
references.pmid: 18265969
references.citation: Pediatrics. 2012 Jun;129(6):e1601-4
references.pmid: 22641760
references.citation: J Ultrasound Med. 2000 Jun;19(6):371-6
references.pmid: 10841057
references.citation: Arch Pediatr Adolesc Med. 1994 Jan;148(1):43-6
references.pmid: 8143008
references.citation: Radiographics. 2006 Sep-Oct;26(5):1485-500
references.pmid: 16973777
references.citation: Radiographics. 2009 Sep-Oct;29(5):1281-93
references.pmid: 19755596
references.citation: J Radiol Case Rep. 2010;4(5):7-12
references.pmid: 22470728
references.citation: Pediatr Radiol. 1992;22(1):18-20
references.pmid: 1594304
references.citation: Surg Endosc. 2011 Jan;25(1):217-20
references.pmid: 20559662
references.citation: J Pediatr Surg. 2006 May;41(5):1005-9
references.pmid: 16677901
references.citation: Semin Pediatr Surg. 2001 May;10(2):49-55
references.pmid: 11329605
references.citation: Nat Med. 1995 May;1(5):460-3
references.pmid: 7585095
references.citation: Curr Pharm Des. 2012;18(38):6232-40
references.pmid: 22762477
references.citation: J Ultrasound Med. 2006 Jan;25(1):99-103
references.pmid: 16371559
references.citation: J Clin Epidemiol. 2003 Aug;56(8):721-9
references.pmid: 12954463
references.citation: Pediatr Radiol. 2009 Apr;39 Suppl 2:S161-3
references.pmid: 19308378
references.citation: J Emerg Med. 2012 Jul;43(1):e49-51
references.pmid: 22325550
references.citation: Br J Surg. 1996 Jan;83(1):105-6
references.pmid: 8653329
references.citation: Semin Pediatr Surg. 2003 Nov;12(4):229-36
references.pmid: 14655161
references.citation: Br J Obstet Gynaecol. 1988 Oct;95(10):1003-6
references.pmid: 3263880
references.citation: J Pediatr Surg. 1992 Oct;27(10):1343-5
references.pmid: 1403518