Management of Sixteen Year Old Male with Intestinal Malrotation by Ladd’s Procedure: A Case Report and Review of Literature

Abstract

Introduction: Intestinal malrotation is an aberration seen during foetal development in neonatal period. The presentation in adolescents and adults is rare and requires prompt diagnosis and surgical intervention namely Ladd’s procedure. Case Report: Here, we discuss a rare case of malrotation in sixteen year old male patient who came to emergency with crampy pain in whole abdomen and vomiting since three days. A contrast enhanced CT scan of abdomen revealed malrotation of small bowel with volvulus. Laparotomy disclosed classic Ladd’s bands and dilated third and fourth part of duodenum extrinsically clogging the misplaced duodenojejunal junction. Ladd’s procedure comprised of widening of mesenteric base, excision of Ladd’s bands followed by appendectomy. Patient was asymptomatic in follow up period. Patients with midgut malrotation may show symptoms of colicky pain in abdomen, intestinal obstruction or ischemia. Ladd’s procedure is gold standard treatment of adolescents or adult patients with intestinal malrotation. Conclusion: In adolescents and adults presenting with the intestinal malrotation, the diagnosis should be prompt and quick. The surgical intervention includes derotation of volvulus, inspecting for viability, Ladd’s band excision and fixing of gut mesentery to the posterior wall of abdomen so as to prevent recurrence of volvulus.