Intussusception in Cases of Malrotation: Is the Association Benign?

A BSTRACT Background: Does a coexisting intestinal malrotation effect the management of intussusception or its results? Objectives: Analysis of the outcomes of intussusception occurring in malrotation cases. Methods: A retrospective study involving intussusception cases with malrotation was performed from January 2018 to December 2022 at a tertiary center. Data regarding demographic details, clinical history, presenting symptoms and signs, management, and follow-up were collected and analyzed. Results: 7.52% of all intussusceptions treated during this period (133) had malrotation. This subset had a mean age of 14.45 months and male predominance (70%). 60% of these cases had previous symptoms like bilious vomiting, failure to gain weight or pain abdomen. Among acute presenting symptoms, bilious vomiting and blood in stools were the commonest (90% each). Ileo-colic type was the commonest type (90%); ultrasound could detect malrotation in only 60% cases. Hydrostatic reduction could succeed in only one of the three cases which also recurred and needed surgery along with other cases. Bowel resection was needed in 30% cases, while the others did well with surgical reduction. Ladd’s procedure was performed in 80% cases during primary surgery and in 20% cases, after recurrence or persistence of symptoms. There was burst abdomen in one patient which necessitated secondary suturing. Conclusion: Intussusception and malrotation have frequent association which must be recognized for appropriate management. Previous clinical symptoms and meticulous ultrasound can often detect associated malrotation; nondetection can lead to recurrence or persistence of symptoms.