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Idiopathic Hypertrophic Pyloric Stenosis with Complete Ladd's Band: A Rare Association

Ahmed M Abo Elyazeed1, Mohamed M Shalaby1, Mohamed M Awad1

  • 1Division of Surgery, Department of Pediatric Surgery, Tanat University Hospital, Tanta, Gharbia, Egypt.

European Journal of Pediatric Surgery Reports
|November 26, 2019
PubMed

Insights

This case report highlights a rare instance of concurrent idiopathic hypertrophic pyloric stenosis and intestinal malrotation in an infant. Early laparoscopic exploration is crucial for accurate diagnosis and effective treatment of complex pediatric surgical conditions.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Neonatal Care

Background:

  • Idiopathic hypertrophic pyloric stenosis (IHPS) is a common cause of infant vomiting.
  • Intestinal malrotation with Ladd's bands is a serious congenital anomaly requiring prompt surgical intervention.
  • Concurrent presentation of IHPS and malrotation is exceptionally rare, posing diagnostic challenges.

Observation:

  • A 45-day-old male infant presented with persistent projectile nonbilious vomiting.
  • Initial ultrasound suggested IHPS, leading to laparoscopic pyloromyotomy.
  • Postoperative vomiting persisted, necessitating further investigation.

Findings:

  • Laparoscopic re-exploration confirmed a complete pyloromyotomy but revealed coexisting intestinal malrotation with a complete Ladd's band.
  • Conversion to open laparotomy and performance of the Ladd's procedure resolved the vomiting.
  • Histopathological confirmation of IHPS was obtained.

Implications:

  • This case underscores the importance of thorough laparoscopic exploration in persistent postoperative vomiting, even after initial corrective surgery.
  • It highlights the rarity and diagnostic complexity of concurrent IHPS and malrotation.
  • A systematic diagnostic approach, including exploration, is vital for managing complex neonatal surgical emergencies.

Keywords:
Ladd's bandLadd's procedurelaparoscopic explorationlaparoscopic pyloromyotomymalrotationpostoperativelyvomiting

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