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Incidental Congenital Small Bowel Malrotation in the Adult Population: Review of Diagnostic and Treatment Strategies
*Maureen V Hill, *Paul A Hill, Kurt K Rhynhart, *D. Joshua Mancini, Eric D Martin
Dartmouth Hitchcock Medical Center, Lebanon, NH
OBJECTIVE: Congenital small bowel malrotation is considered a surgical emergency in the pediatric population regardless of symptomatology. Incidentally discovered malrotation has been noted in the adult population undergoing computed tomography (CT) scans of the abdomen. Our objective was to identify these patients and to evaluate current diagnostic and treatment strategies.
DESIGN: Retrospective review
SETTING: Academic medical center
PATIENTS: MontageTM software used to identify adult patients with “malrotation”, “non-rotation”, or “volvulus” on CT scan of the abdomen.
INTERVENTIONS:
MAIN OUTCOME MEASURES: CT scan reads and indication for the scan were reviewed. Surgical history and subsequent follow up with confirmatory study, defined as small bowel follow through (SBFT) or surgical exploration within 30 days of scan, was tracked.
RESULTS: 84 patients were deemed suspicious for malrotation. 16 patients were excluded from analysis after review (10 for prior Ladd’s procedures, 6 for prior duodenal manipulation). 68 patients were analyzed; 38 (55.9%) obtained the CT scan for abdominal pain. Of these 38 patients, 17 (44.7%) underwent confirmatory study. In the 30 patients who had CT scan performed for another indication, 8 (26.7%) had a confirmatory study (p=0.14). Of the 22 patients who underwent a confirmatory study, 5 patients had malrotation; 2 by SBFT, 3 by surgical exploration. Neither patient in the SBFT group underwent a subsequent surgery. Only 1 patient, who did not have a confirmatory study, subsequently required surgical exploration >30 days after CT scan secondary to continued symptoms.
CONCLUSION: The incidental finding of small bowel malrotation on CT scan leads to variable management strategies. Even in the setting of abdominal pain as the indication for CT, less than half of patients go on to a confirmatory study.
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