The risk of midgut volvulus in patients with abdominal wall defects: A multi-institutional study

Infographic · Oct 2018 · 1 min read

In brief

Multi-institutional study of 414 patients found omphalocele carries 4.4% midgut volvulus risk versus 1.0% in gastroschisis. Authors recommend considering prophylactic Ladd procedure during omphalocele repair to reduce volvulus risk in this higher-risk population.

Midgut volvulus occurred in 1.9% of abdominal wall defect patients overall (1.0% gastroschisis vs 4.4% omphalocele, p=0.04)
Omphalocele patients have 4-fold higher risk of midgut volvulus compared to gastroschisis patients
Consider performing Ladd procedure during definitive omphalocele repair to prevent midgut volvulus
Multi-institutional data (n=414) supports risk-stratified approach to malrotation management in abdominal wall defects

Written by the GCMD Library team from the infographic.

The infographic uses a light teal background with two side-by-side anatomical line drawings showing bowel positioning. The left illustration depicts bowel protruding outside the abdominal wall (omphalocele), while the right shows compact bowel within the abdomen (gastroschisis). Below each illustration are corresponding case numbers and midgut volvulus rates presented in a table format.

Background

The management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure.

Methods

A retrospective chart review was performed for all patients managed at three institutions born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy.

Results

Of the 414 patients identified with abdominal wall defects, 299 patients (72%) had gastroschisis, and 115 patients (28%) had omphalocele. The mean gestational age at birth was 36.1 ± 2.3 weeks, and the mean birth weight was 2.57 ± 0.7 kg. There were a total of 8 (1.9%) cases of midgut volvulus: 3 (1.0%) patients with gastroschisis compared to 5 patients (4.4%) with omphalocele (p = 0.04).

Conclusions

Patients with omphalocele have a greater risk of developing midgut volvulus, and a Ladd procedure should be considered during definitive repair to mitigate these risks.