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A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

Anita Lamichhane1, Rupesh Sharma2, Ramana Rajkarnikar3

  • 1Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal.

JNMA; Journal of the Nepal Medical Association
|September 24, 2020
PubMed

Insights

Failure to thrive and vomiting in older children can indicate intestinal malrotation with Ladd's band. Early diagnosis and surgical intervention, like the Ladd procedure, are crucial for managing this rare condition.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Medical Diagnostics

Background:

  • Vomiting and failure to thrive in older children present diagnostic challenges due to varied etiologies.
  • Intestinal malrotation is a congenital anomaly that can lead to significant gastrointestinal issues.

Observation:

  • A 5-year-old girl presented with failure to thrive, recurrent vomiting, and abdominal pain since infancy.
  • Clinical presentation, high-resolution computed tomography (HRCT), barium follow-through, and intraoperative findings confirmed intestinal malrotation with Ladd's band.

Findings:

  • The patient underwent exploratory laparotomy and Ladd's procedure for malrotation at the duodenojejunal junction, characterized by a short mesentery and a mobile cecum.
  • Surgical findings confirmed malrotation with a Ladd's band, a rare presentation in older children.

Implications:

  • This case highlights the importance of considering intestinal malrotation in older children with unexplained failure to thrive and vomiting.
  • Timely diagnosis and surgical management of malrotation are essential to prevent long-term complications and improve patient outcomes.
  • Reporting rare pediatric cases enhances awareness and knowledge for improved clinical practice.

Keywords:
exploratory laparotomy; failure to thrive; intestinal malrotation.

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