Child presents with recurrent abdominal pain and bilious vomiting. Condition was diagnosed by barium follow through. Surgery was done, - mesentric widening, appendicectomy, cutting the Ladd's band. What is the diagnosis?
Malrotation The surgey mentioned in the question is Ladd's procedure done for malrotation. 3 things are done: A. Lysis of cecal and duodenal bands. B. Broadening of the mesentery. C. Appendectomy. Obstruction in a patient with malrotation can occur because of mid gut volvulus or because of bands (Ladd's band). Midgut volvulus can occur at any age, although it is seen most often in the first few weeks of life. Bilious vomiting is usually the first sign of volvulus, and all infants with bilious vomiting must be evaluated rapidly to ensure that they do not have intestinal malrotation with volvulus. When volvulus is suspected, early surgical intervention is done to avoid or reverse the ischemic process. Surgery: Volvulus occurs clockwise, and it is therefore untwisted counterclockwise. (This can be remembered by using the memory aid "Turn back the hands of time.") Subsequently, Ladd's procedure is performed. This operation does not correct the malrotation but does broaden the narrow mesenteric pedicle to prevent volvulus from recurring. Steps done in Ladd's procedure are: - duodenal and cecal bands are divided, - Broadening of the mesentery - The appendix is removed to avoid diagnostic errors in later life. This maneuver brings the straightened duodenum into the right lower quadrant and the cecum into the left lower quadrant. Note that: A subset of patients with malrotation can also present with incomplete obstruction or chronic obstruction. (so the patient here in this question has either incomplete volvulus or obstruction because of-duodenal hand) Ladd's procedure is performed to prevent voluvulus ; however, volvulus can still occur rarely after Ladd's procedure.
Recurrent Caecal volvulus
Mal rotation
Recurrent appendicitis
Stricture TB