Age of Presentation for Malrotation with Volvulus
Malrotation with midgut volvulus occurs most commonly in the neonatal period and early infancy, with 40% presenting in the first month of life and 73% within the first year, though it can present at any age and requires a high index of suspicion even in older children. 1
Age Distribution
The American College of Radiology provides clear age-based epidemiology for this surgical emergency:
- 40% of cases present during the neonatal period (first 28 days of life) 1
- 73% of all cases occur within the first year of life 1
- The remaining 27% can present beyond infancy, including school-age children and even adolescents 1
Research data corroborates this pattern, showing that while 39% of patients had symptoms within the first 10 days of life, 50% were older than 2 months of age at presentation 2. One series documented cases ranging from 1 day to 12 years of age 3, and another reported cases between ages 7-12 years 4.
Age-Related Clinical Presentation Differences
Neonates and young infants:
- Present with acute bilious vomiting, typically within the first 2 days of life 1
- More likely to have the classic acute presentation requiring emergency intervention 1
Older children:
- Often have a longer course of vague, antecedent symptoms 2
- May present with intermittent, nonbilious vomiting and chronic abdominal pain rather than acute bilious vomiting 2, 5
- Recurrent abdominal pain may be the predominant symptom 5
Critical Clinical Pitfall
The most important caveat is that volvulus, intestinal gangrene, and mortality can occur regardless of age or chronicity of symptoms 2. This means:
- Even older children with chronic, vague symptoms can develop catastrophic midgut volvulus 2
- It remains impossible to predict which patients will have life-threatening complications based on age or presentation type 2
- A high index of suspicion is required when evaluating children of all ages with possible malrotation 2
Management Implications by Age
The American College of Radiology emphasizes that suspected midgut volvulus is a true surgical emergency requiring immediate laparotomy, and surgery should not be delayed for additional imaging 1. This applies regardless of patient age 2.
Even incidentally discovered malrotation (found in 21% of cases while evaluating seemingly unrelated conditions) warrants Ladd's procedure, as no morbidity or mortality occurred in patients who underwent semielective surgery, whereas all mortalities occurred in patients with volvulus and intestinal necrosis 2.