Laparotomy for Midgut Volvulus

Abstract

This chapter describes the surgical procedure for laparotomy for midgut volvulus as performed by the following approach: open. Indications for this procedure are classically bilious emesis in a child. An upper gastrointestinal contrast study typically confirms the diagnosis of midgut volvulus prior to operative intervention. However, in a child with bilious emesis and peritonitis, often the child is brought directly to the operating room for exploratory laparotomy due to the time-dependent nature of the diagnosis. Risks of the operation include the need for bowel resection, possible ostomy creation, and possible second-look laparotomy. There are no alternatives to surgery in the management of midgut volvulus. Essential steps include derotation of the midgut in a counter clockwise manner, lysis of Ladd’s bands of the duodenum and vascular pedicle, and appendectomy (optional).