Incidence of intestinal volvulus in pediatric patients with intestinal malrotation: A single institution's experience

• Long-term cumulative risk of volvulus assessed from infancy to 15 years. • Typical malrotation without comorbidities showed highest volvulus incidence. • Volvulus risk peaked at ages 0–1 year and persisted across childhood. • Duodenal third portion anatomy used as a stratification factor. • Rates of bowel necrosis and surgical complications were quantified. We investigated the future occurrence of intestinal volvulus in pediatric patients with intestinal malrotation, regardless of whether they are symptomatic or asymptomatic. Among 148 pediatric patients with intestinal malrotation, categorization was based on the presence/absence of underlying conditions and the duodenal third portion. Patients with and without the occurrence of intestinal volvulus were compared. We evaluated the cumulative future occurrence of intestinal volvulus from a specified age to 15 years old. The incidence of intestinal malrotation-associated bowel necrosis/surgical complications was recorded. Seventy-nine of 107 Patients without underlying conditions and without the duodenal third portion, who are typically classified as having the typical type of intestinal malrotation, had intestinal volvulus, and those had significantly higher incidence of intestinal volvulus than that including all patients. The cumulative future occurrence of intestinal volvulus among patients without underlying disease and without duodenal third portion was 73.8%, and remained at approximately 30% across other age groups. Among all patients in the present study, including those with and without underlying disease and with typical or atypical malrotation, the incidence was highest at 0–1 years of age (56.1%) and remained at approximately 20% across other age groups. Intestinal necrosis/surgical complications occurred in 9.6%/23.1% of patients, respectively. Intestinal volvulus occurs most frequently at 0–1 years of age and remains a risk in the future. These findings, along with considerations of underlying disease, duodenal anatomy, bowel necrosis risk, and surgical complications, provide useful information to assist pediatric surgeons in managing this patient cohort.