Late-onset volvulus without malrotation in preterm infants

PurposeThe aim of the study was to report a new observation of late-onset volvulus without malrotation (VWM) in preterm infants.MethodsThe study used medical note review of infants with VWM identified at a single regional centre between 1996 and 2007.ResultsTen patients were identified. Group 1 includes 4 patients (gestation, 28-38 weeks; median, 32) who presented within 4 days of age (range, 1-4; median, 3). Group 2 includes 6 patients (gestation, 25-33 weeks; median, 27), who presented later (range, 22-57 days; median, 45). Characteristics of group 2 patients included recurrent episodes of abdominal distension and bile vomiting (6/6), long-term continuous positive airway pressure requirement (5/6), and sudden, severe deterioration with acute abdominal signs (6/6). Small bowel volvulus was found at laparotomy requiring resection (30%-70% of total small bowel) and either primary anastomosis (4) or stoma formation (2). All babies survived.ConclusionsThere appear to be 2 clinical groups with VWM—one presenting within the first few days of life and the other presenting after the first month of life associated with a specific clinical history. This latter group has not been described before.