Laparoscopic Ladd procedure for the diagnosis and treatment of a newborn with suspected malrotation and volvulus: A video presentation
M Erman, E Divarcı, MO Ergün, A Çelik, G Özok
Ege University, Faculty of Medicine, Department of Pediatric Surgery, İzmir
Purpose: The diagnosis of malrotation and volvulus should be excluded in first place in newbornes presented with bilious vomiting. Radiological-clinical findings can be inconsistent in some cases.It was aimed to present the diagnosis and minimally invasive surgery procedure of a newborn, admitted with suspicious clinical findings whereas suspected of volvulus radiologically.
Video method and results:A fifteen day old female newborn presented with bilious vomiting.There were no signs of peritonitis on physical examination.Spontaneous stool output was present. Distension in abdomen wasn’t inspected. Neither physical examination nor pathologic evidence in patient’s biochemistry tests suggested requirement of any surgical intervention. However, ultrasonography indicated that malrotation and volvulus may present. Upper GI tract radiography was examined.Significant findings were detected in terms of malrotation along with partial obstruction in intestines. The patient was evaluated with the current clinical state and radiological findings and a diagnostic laparoscopy and if necessary, minimally invasive surgery had been planned.During laparoscopic exploration, Ladd bands pressing on the duodenum and one complete torsion of midgut volvulus (with no affected intestinal blood circulation) were determined. A 5mm trocar was inserted through umbilicus along with 3mm trocars on right upper and left upper quadrant.After Ladd bands were resected by hook cautery intestinal segments from caecum to proximally were inspected, ileal segments were found to be volvulated abdout 1 complete torsion around the meso. Derotation was performed along with Meso expansion.Appendix was took out from umblilical trocar hole after intracorporeal appendectomy had been applied. As caecum and colon is placed on the left side and the small intestines has been moved the right side.The patient was orally fed on the first day and discharged next day.
Conclusion: Malrotation and volvulus should be excluded firstly in every newborn presented with bilious vomiting.In experienced centers, diagnosis and treatment can be successfully managed with minimally invasive surgery.
Keywords: Malrotation, Volvulus, Bilious vomiting,Minimal invasive surgery, Newborn