INTESTINAL MALROTATION IS ASSOCIATED WITH VISCERAL HYPERSENSITIVITY IN ADULT PATIENTS
Kevin Harris*1, Matthew Hoscheit1, Armanyous Sherif2, Guilherme Costa2, Kareem Abu-Elmagd2, Scott L. Gabbard3
1Internal Medicine, Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Center for Gut Rehabilitation and Transplantation, Department of Surgery, Cleveland Clinic, Cleveland, OH; 3Gastroenterology, Cleveland Clinic, Cleveland, OH
Background: Intestinal malrotation (IM) is a rare condition which occurs during fetal development due to incomplete intestinal rotation around the superior mesenteric artery. The incidence of IM is estimated to be 1 in 6000 live births. Malrotation is typically diagnosed in the neonatal period with 90% of cases diagnosed within the first year of life. The pathophysiology of abdominal pain in adults with IM is poorly understood. Further studies are needed to explore the relationship between gastrointestinal motility and chronic abdominal pain in adults with IM.
Aim: This study aims to determine if adults with IM demonstrate abnormal gastrointestinal motility and visceral hypersensitivity. We hypothesize adult patients with IM have abnormal orocecal transit time (OCTT) and increased visceral hypersensitivity compared to commonly accepted normal ranges.
Methods: Retrospective demographic and clinical data were collected on 34 adult patients who underwent intestinal reorganization surgery for IM at a tertiary care center in the Midwest. A two-sided T test was used to compare pre-surgical and post-surgical OCTT. Abnormal OCTT was defined as <30 min or >150 min.
Results: Of the 34 patients with IM, 7 (21%) had both pre and post-surgical small bowel follow through for comparison. Five patients had pre-surgical anorectal manometry (ARM) with 60% showing evidence of rectal hypersensitivity (rectal pain/discomfort threshold < 100 mL). Patients with IM had a mean pre-surgical OCTT of 207 minutes. Two patients had rapid, 2 patients had normal and 3 patients had delayed pre-surgical OCTT. Following intestinal reorganization surgery patients had a mean OCTT of 111 minutes (p=0.350). All patients with delayed pre-surgical OCTT experienced improvement in their OCTT following surgical reorganization (Table 1).
Conclusions: Adult patients with IM were likely to have abnormal OCTT, and the majority had visceral hypersensitivity compared to commonly accepted normal ranges. Intestinal reorganization surgery improved patient's orocecal transit time in 57% of cases but this improvement failed to meet statistical significance (p=0.350). Intestinal dysmotility and visceral hypersensitivity play a key role in the clinical presentation of adults with intestinal malrotation. Future prospective studies are needed to further characterize the association between intestinal malrotation and visceral hypersensitivity.
Table 1. Orocecal Transit Time (OCTT) Pre and Post Intestinal Reorganization Surgery
| Patient Number | Pre-surgery OCTT (minutes) | Post-surgery OCTT (minutes) |
| 1 | 25 | 30 |
| 2 | 30 | 30 |
| 3 | 60 | 120 |
| 4 | 130 | 90 |
| 5 | 240 | 60 |
| 6 | 260 | 198 |
| 7 | 705 | 225 |
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