Intestinal Malrotation in Children: Incidence, Predisposing Factors, and Surgical Management: A Single-Centre Observational Study from Al-Karama Teaching Hospital, Wasit, Iraq

Abstract

Intestinal malrotation is caused by the lack of complete counterclockwise rotation of the embryonic midgut, leaving the mesenteric base of the bowel dangerously small and thus providing the circumstances of midgut volvulus a life-threatening emergency situation requiring urgent surgical intervention. The current study narrates a mixed observational experience of five years (January 2020 to December 2024) in Al-Karama Teaching Hospital, which is the only paediatric surgical referral centre in Wasit Governorate, Iraq. A total of 27 children under the age of 14 years having malrotation radiologically or operatively confirmed were enrolled. An incidence of 1.8 per 10,000 live births was estimated from regional registry data. Over three-fifths of the cohort were neonates (median diagnosis age: 11 days; IQR 5–42) and bilious vomiting was the defining complaint in 89% of cases. Almost half of the patients (44.4%) had one or more related congenital anomaly, with the most common being cardiac anomalies (n=5) and heterotaxy syndrome (n=3). The 25 surgically treated children all received Ladd procedure with two more needing to have bowel removed due to proven ischaemia. Mortality was 7.4% after 30 days, all of which were in patients presenting after the 48-hour limit. Multivariate modelling revealed delayed presentation (aOR 8.4; 95% CI 1.6–44.2; p=0.012) and heterotaxy syndrome (aOR 6.1; 95% CI 1.1–33.8; p=0.039) to be the only independent predictors of poor outcome. These findings suggest that patient survival is determined less by technological capacity than by the speed of recognition and referral.