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Laparoscopic finding of chylous ascites and intestinal malrotation in an infant presenting with left inguinal hernia
Faiz U Shariff1, Joe Curry, Paolo De Coppi
1Department of Paediatric Surgery, Great Ormond Street Hospital, London, United Kingdom.
Insights
Laparoscopic inguinal hernia repair in infants unexpectedly revealed malrotation with obstruction. This surgical approach facilitated early diagnosis and treatment of a serious congenital anomaly, ensuring a positive outcome.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Inguinal hernias are common in infants, often requiring surgical repair.
- Laparoscopic techniques are increasingly used for pediatric inguinal hernia repair.
- Congenital anomalies can present concurrently with inguinal hernias.
Observation:
- A case report details an infant with an irreducible left inguinal hernia presenting with bilious vomiting.
- During laparoscopic surgery for the hernia, chylous ascites and non-visualized abdominal organs were noted.
- These intraoperative findings raised suspicion for intestinal malrotation with obstruction.
Findings:
- An upper gastrointestinal contrast study confirmed intestinal malrotation with obstruction.
- The infant underwent laparotomy for a Ladd's procedure to correct the malrotation and volvulus.
- The patient experienced an uneventful recovery following the corrective surgery.
Implications:
- Laparoscopy for infant inguinal hernias can provide an unexpected diagnostic advantage for intra-abdominal anomalies.
- Early detection of malrotation with obstruction via laparoscopy can prevent serious complications.
- This case highlights the importance of vigilant intraoperative assessment during pediatric hernia repairs.
Abstract:
This case report illustrates an unexpected advantage of using the laparoscopic approach for inguinal hernia repair in infants. In this paper, we report an infant referred to us with a diagnosis of an irreducible left inguinal hernia. He presented with a 1-day history of bilious vomiting and poor weight gain on breastfeeding. On arrival, a reducible left inguinal hernia was found and he was scheduled to have a laparoscopic inguinal hernia repair. During laparoscopy, chylous ascites was noted and the transverse colon and appendix could not be visualized. This raised the suspicion of malrotation with obstruction, which was confirmed on an upper gastrointestinal contrast study. He was taken back to the operating theater and a malrotation with volvulus was confirmed at laparotomy. A Ladd's procedure was performed, and he made an uneventful recovery.
