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Laparoscopic evaluation and treatment of intestinal malrotation in infants
1Section of Pediatric Surgery, LeBonheur Children's Medical Center, University of Tennessee, Memphis 38105, USA.
Insights
Laparoscopy can diagnose and treat intestinal malrotation in infants, especially when traditional imaging is inconclusive. This minimally invasive approach offers a valuable alternative for confirming and correcting this congenital condition.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Radiology
Background:
- Intestinal malrotation is a congenital anomaly often presenting with bilious emesis in infants.
- Diagnosis typically relies on upper gastrointestinal (UGI) barium studies, assessing the position of the ligament of Treitz.
Observation:
- Traditional contrast studies, like barium enema, can be unreliable due to cecal mobility.
- Two infants with recurrent vomiting showed suggestive UGI findings but lacked classic radiographic signs of malrotation.
Findings:
- Laparoscopic exploration confirmed malrotation in both infants.
- Laparoscopic Ladd's procedure was successfully performed in one infant, with the other undergoing a traditional Ladd's procedure.
Implications:
- Laparoscopy offers a diagnostic and therapeutic option for intestinal malrotation, particularly in ambiguous cases.
- It may be particularly useful for confirming diagnoses when radiographic findings are atypical.
- The role of laparoscopy in midgut volvulus management requires further consideration due to potential technical challenges.
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.