Malrotation with Distal Duodenal Necrosis in a Neonate (original) (raw)
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Intestinal malrotation presenting outside the neonatal period
Archives of Disease in Childhood, 1986
We report 37 patients ranging in age from 1 month to 14 years treated for intestinal malrotation during a five year period. The main presenting features consisted of intermittent attacks of vomiting (15 patients), failure to thrive (seven), and recurrent colicky abdominal pain (seven). The diagnosis was confirmed by gastrointestinal contrast studies in all but three patients. A standard Ladd's procedure comprised the definitive surgical treatment. We emphasise the poor nutritional state at the time of operation (49% of the cases were on or below the third centile). In contrast with neonatal presentation, volvulus of the midgut occurred in only five patients (14%) compared with 68% in neonates with malrotation. There were two deaths in the series. Ninety four per cent of the remaining patients responded favourably to the operative procedure. Malrotation should be considered in the differential diagnosis of a wide variety of symptoms and should be treated promptly once the diagnosis has been confirmed.
Intestinal malrotation: a diagnosis to consider in acute abdomen in newborns
Residência Pediátrica, 2018
Intestinal malrotation is an anomaly of the midgut, resulting from an embryonic defect during the phases of herniation, rotation, and fixation. The objective is to report a case of complex diagnostics and approach. The diagnosis was made surgically in a patient presenting with hemodynamic instability, abdominal distension, signs of intestinal obstruction, and pneumoperitoneum on abdominal X-ray, with suspected grade III necrotizing enterocolitis. During surgery, a volvulus resulting from poor intestinal rotation was found at a distance of 12 cm from the ileocecal valve. Hemodynamic instability and abdominal distension recurred, and another exploratory laparotomy was required to correct new intestinal perforations. Therefore, early diagnosis with surgical correction before a volvulus appears is essential. Abdominal Doppler ultrasonography has been promising for early diagnosis.
Double Whammy: Duodenal Stenosis and Gastrointestinal Malrotation
Cureus
One of the main causes of proximal bowel obstruction in neonates is congenital duodenal obstruction. It can be grouped by intrinsic and extrinsic factors and the presentation may differ depending on whether the obstruction is complete or partial. The intrinsic factors include duodenal atresia, duodenal stenosis, or duodenal web. The extrinsic factors include malrotation with Ladd's band, annular pancreas, anterior portal vein, and duodenal duplication. Malrotation may present with or without midgut volvulus. We are sharing a rare presentation of congenital duodenal obstruction with combined intrinsic and extrinsic causes, namely, duodenal stenosis with gastrointestinal malrotation in a neonate. The patient underwent successful exploratory laparotomy, corrective Kimura's procedure (duodenostomy), Ladd's procedure, and appendicectomy. Early recognition of signs and symptoms, prompt corrective surgery, and adequate optimization of metabolic components post-operatively are important to determine the decreased morbidity and mortality of neonates.
Asian Journal of Medical Sciences
Background: Malrotation commonly presents in neonates with bilious vomiting. It may also present in post neonatal age group with vague symptoms such as chronic abdominal pain, vomiting, and failure to thrive. These indistinct symptoms also result in delay of diagnosis. Aims and Objectives: This study is done with an objective to know whether age of presentation in malrotation determines morbidity and mortality. Materials and Methods: This is a retrospective study conducted in Gandhi medical college and Hospital, Hyderabad, from 2017 to 2020, based on the records of 50 patients who were diagnosed to have malrotation. The differences in clinical presentations, diagnosis, management, and outcomes were analyzed with respect to age. Results: Children who presented in neonatal period had classical symptoms (P<0.00001) and early diagnosis (P<0.0239). Children who presented later (>1 month of age) had higher incidence of atypical symptoms (P<0.00001) and delay in diagnosis (P<...
2021
Bowel malrotation is an abnormality in the rotation of the primary intestinal loop during embryonic life. It is a severe abnormality exposing the patient to fatal complications. We report here a series of five patients presenting digestive malrotation with various malformative associations. The first three cases are multiple intestinal atresia on incomplete common mesentery. They underwent an intestinal anastomosis: end-lateral duodeno-ileal for one and end-to-end jejuno-jejunal for the other two with Ladd procedure. In the latter two cases, the omphalocele was the associated malformation; complications such as rupture of the omphalocele with intestinal perforation for one and occlusion by strangulation at the level of the neck for the other were recorded. Ileal resection removing the perforation with end-to-end ileo-ileal anastomosis was performed for the first, while reduction of strangulation at the origin of the occlusion was sufficient for the second. The LADD procedure was the...
Midgut malrotation: case series
International Surgery Journal
Mal rotation of midgut is associated with other anomalies usually encountered in neonatal period or early childhood. If undetected in childhood it presents in adulthood with small bowel obstruction, repeated appendicitis or chronic abdominal symptoms. CECT abdomen is mandatory for diagnosis though it often presents as surgical surprise on abdominal laparotomy. Hereby, we presented 3 cases where it was undetected till adulthood though CECT was mandatory for definitive diagnosis. Case 1 patient presented with chronic abdominal pain on left abdomen was actually malrotation with appendix lying on left hypochondrium and stenosed fourth part duodenum adding to vomiting off and on. Case 2 patient in adulthood presented with repeated sub-acute intestinal obstruction because of midgut mal-rotation. Relieved after Ladd band was cut and obstructive symptoms relieved. Case 3 patient had inflammed appendix in subhepatic position was cause of chronic pain with para duodenal hernial sac adding to ...
Pan African Medical Journal, 2018
Congenital intestinal malrotation is a gastrointestinal anomaly whose most serious complication is midgut volvulus. More commonly, it presents as an incidental finding at laparotomy, or as a finding on diagnostic imaging (Ultrasound, CT, Upper GI contrast study). Most patients are diagnosed in childhood. Laparoscopic Ladd's procedure is an accepted alternative to Laparotomy in children but has not been well-studied in adult. We present the case of this unexpected finding in a patient 38 years old, during emergency laparotomy for mechanical intestinal obstruction. Intraoperative findings included intestinal malrotation with small bowel volvulus. The terminal ilea and cecum were gangrenous on the basis of ischemic necrosis. A limited right hemycolectomy and primary end-to-end anastomosis was performed.
Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study
Surgical endoscopy, 2011
Intestinal malrotation in neonates or infants may require urgent surgical treatment, especially when volvulus and vascular compromise of the midgut are suspected. Successful laparoscopic management of malrotation has been described in a number of case reports. It remains unclear, however, whether laparoscopy for the treatment of malrotation has a success rate equal to that of open surgery and what relative risks exist in terms of conversion and redo surgery in larger numbers of patients. This report describes a retrospective analysis of the clinical outcome for 45 children who underwent laparoscopic treatment of intestinal malrotation at the authors' institution. The 45 patients in this series, ages several days to 13 years, underwent a diagnostic laparoscopy for suspected intestinal malrotation. For 37 patients, malrotation with or without volvulus was diagnosed. All these patients underwent laparoscopic derotation and Ladd's procedure. Successful laparoscopic treatment of ...