Intestinal malrotation

Prognosis after volvulus

Mortality with midgut volvulus is approximately 10% and usually depends on degree of intestinal necrosis.[21]Warner BW. Malrotation. In: Oldham KT, Colambani PM, Foglia RP, eds. Surgery of infants and children: scientific principles and practice. Philadelphia, PA: Lippincott-Raven; 1997:1229-1240. Survivors of volvulus are at risk for recurrent volvulus of around 10%.[22]Stewart DR, Colodny AL, Daggett WC. Malrotation of the bowel in infants and children: a 15 year review. Surgery. 1976;19:716-720. http://www.ncbi.nlm.nih.gov/pubmed/1273757?tool=bestpractice.com However, these estimates are likely to be low given the lack of lifelong follow-up in a large cohort. Future adhesive bowel obstruction is possible after any abdominal operation.

Prognosis after Ladd procedure for malrotation

Mortality is entirely determined by bowel necrosis. Patients with malrotation without volvulus still have the possibility of volvulus after the Ladd procedure, as the procedure does not create complete rotation but rather nonrotation. This risk is impossible to precisely quantify and is certainly inversely related to the width of the base of the mesentery.