Intestinal Ischemia Secondary to Ladd's Bands Obstruction Associated With Intestinal Malrotation in a One-Year-Old...

Intestinal malrotation is a congenital anomaly resulting from an alteration in the rotation and fixation of the midgut during embryonic development. Ladd's bands are abnormal peritoneal adhesions that can cause extrinsic compression of the bowel, obstruction, and vascular compromise, leading to intestinal ischemia. Although the diagnosis is typically made in the neonatal period, late presentations exist, posing a diagnostic and therapeutic challenge. We describe the case of a previously healthy one-year-old male patient who was admitted for feeding intolerance, accompanied by vomiting, progressive abdominal distension, and abdominal pain with clinical signs of peritoneal irritation. Laboratory tests showed an elevated C-reactive protein (71 mg/L) level without significant alterations in the acid-base balance or marked lactate elevation. An abdominal CT scan revealed a bowel obstruction with a transition zone in the terminal ileum. Given the clinical deterioration, an emergent exploratory laparotomy was performed, identifying ischemia in approximately 100 cm of the terminal ileum secondary to Ladd's bands. Ladd's bands constitute an infrequent but severe cause of bowel obstruction in pediatrics. Early diagnosis and prompt surgical intervention are essential to reduce morbidity and mortality and to preserve the greatest possible bowel length, thereby avoiding bowel resections.