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Surgical Endoscopy

, Volume 10, Issue 9, pp 936–937 | Cite as

Laparoscopic evaluation and treatment of intestinal malrotation in infants

  • E. Gross
  • M. K. Chen
  • T. E. Lobe
Case Reports

Abstract

Infants with intestinal malrotation present with bilious emesis and the diagnosis is generally obtained by an upper gastrointestinal barium study. Malrotation is suspected if the ligament of Treitz is not positioned to the left of the vertebral body. Barium enema may also be used to detect malrotation by noting the abnormal position of the cecum from its usual placement in the right lower quadrant, but this study is not as reliable due to the mobility of the cecum. Some infants may not have classic radiographic findings for malrotation, yet the contrast studies are not entirely normal. We recently treated two infants with recurrent vomiting whose UGI studies suggested intestinal malrotation. Laparoscopic exploration confirmed the diagnosis of malrotation. Laparoscopic correction (Ladd's procedure) of malrotation was carried out in one infant. The second infant underwent a traditional Ladd's procedure. The technique of laparoscopic Ladd's procedure is described. Laparoscopy may be used for the diagnosis and treatment of infants with intestinal malrotation. It may be especially helpful to verify the diagnosis in patients who do not have classic radiographic findings. Whether laparoscopy should be used in patients with midgut volvulus is debatable. Laparoscopic derotation of the volvulus in a setting where the bowel is markedly distended may be difficult and dangerous.

Key words

Laparoscopy Malrotation Ladd's procedure 

References

  1. 1.
    Ladd WE (1932) Congenital obstruction of the duodenum in children. N Engl J Med 206: 277–283Google Scholar
  2. 2.
    Powell DM, Othersen HB, Smith CD (1989) Malrotation of the intestines in children: the effect of age on presentation and therapy. J Pediatr Surg 24: 777–780PubMedGoogle Scholar
  3. 3.
    Simpson AJ, Leonidas JC, Krasna IH, Becker JM, Schneider KM (1972) Roentgen diagnosis of midgut malrotation: value of upper gastrointestinal radiographic study. J Pediatr Surg 7: 243–252CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc 1996

Authors and Affiliations

  • E. Gross
    • 1
  • M. K. Chen
    • 1
  • T. E. Lobe
    • 1
  1. 1.Section of Pediatric Surgery, LeBonheur Children's Medical CenterUniversity of Tennessee, MemphisMemphisUSA

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