Brian Bassiri-Tehrani, MD, Robert A Andrews, MD. Lenox Hill Hospital
Introduction: Intestinal malrotation occurs in about 1 in 200 to 1 in 500 live births. Despite this, however, not all patients present with signs and symptoms of an acute obstruction or volvulus. In fact, most patients are asymptomatic and are incidentally diagnosed later in life. Symptomatic malrotation occurs rarely, occurring in only 1 in 6,000 live births. Patients who are asymptomatic at birth may develop signs and symptoms of obstruction or volvulus at any age. Though historically the Ladd Procedure was done as an open procedure, with improvements of techniques and proficiency in laparoscopy, it has been shown that the Ladd procedure can be safely done totally laparoscopically.
Case Description: This is an interesting video case presentation of a 26 year old male with no significant past medical or surgical history who initially presented with signs and symptoms of a small bowel obstruction. A work up including a CT scan and a contrast esophagram was suggestive of intestinal obstruction secondary to intestinal malrotation. The patient was taken to the operating room for a diagnostic laparoscopy and Ladd procedure.
Discussion: Upon entry into the peritoneal cavity laparoscopically, the stomach and duodenum were distended, and the cecum was fixed in the right upper quadrant along the lateral abdominal wall. The culprit Ladd band between the duodenum and colon was visualized, which was likely the transition point of obstruction. After careful lysis of Ladd bands, the duodenal obstruction was relieved. The appendix was visualized and removed so as not to confound future diagnoses should the patient suffer from appendicitis. The colon was placed in the left side of the abdomen and the duodenum coursed down caudally without crossing over to the left side of the peritoneal cavity.
Conclusion: Postoperatively the patient did well. His pain was controlled and he was tolerating a regular diet. He was discharged from the hospital on postoperative day four without any complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86364
Program Number: V076
Presentation Session: Acute Care Session
Presentation Type: Video