CORRECTION OF MALROTATION

REASON FOR VISIT:

• Midgut vulvulus
• Bilious vomiting
• Abdominal pain
• Abdominal distention
• The passage of blood and mucus in their stool
• Recurrent abdominal pain and vomiting

RISK ASSESSMENT

• Family history of bleeding disorders

• Unstable cardiovascular system
• Liable heat control
• History of bleeding disorders
• History of allergy to
Medications
Anesthesia

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• Plain abdominal radiography
• Upper gastrointestinal series
• Contrast enema
• CT scanning
• Ultrasonography
• Preoperative antibiotics were administered to the patients with
diseases of the heart valves
• Oral feeding was stopped for ___hrs before procedure
• Electrolyte imbalance, fluid imbalance, acid/base imbalance was
corrected by using the intravenous infusion
• Nasogastric tube was placed
• The NG tube was adjusted to low intermittent suction in order to
decompress the bowel proximal to any obstruction that may be
present.
• Central venous catheter was placed
• Part was prepared draped in sterile fashion
ANESTHESIA:
General anesthesia

POSITION OF THE PATIENT

Supine position

THE PROCEDURE

THE LADD PROCEDURE:

Open Ladd procedure

Laparoscopic Ladd procedure

OPEN LADD PROCEDURE

• Abdominal incision was given from _________ to _____

• And abdomen is opened in layer by layer
• The muscles were separated and blood vessels, nerves were
protected
• Midgut vulvulus was present, the entire small intestine along
with the transverse colon was delivered out of the abdominal
incision
• The volvulus twisted in a clockwise direction, reduction was
done by twisting the vulvulus in a counterclockwise direction.
• The blood supply was restored by detorsion
• Gangrenous bowel was presented from _______to_____
• Gangrenous bowel was resected, and primary anastomosis
was performed.
• Enterostomy was performed.
• Duodenal obstruction was present
• Peritoneal bands were crossing the duodenum
• Ligated the peritoneal bands with taking careful attention to
protecting the superior mesenteric vessels.
• Extrinsic obstruction was found due to the caecum,/ colon,
/SMA impinging on the duodenum
• Relief is obtained by placing the caecum with its mesentery in
the left upper quadrant and exposing the anterior duodenum
through its entire length.
• Nasogastric tube was passed though the duodenum and
obstruction was not found.
 • Appendectomy –was done due to normal anatomical
placement of the appendix is disrupted
• The peritoneum and fascia of the transversalis muscle was
closed with a running absorbable suture.
• The remaining fascial layers were closed with the running or
interrupted absorbable sutures.
• The skin was closed with a subcuticular absorbable suture
such as Monocryl.
• Collodian or adhesive Steri-strips are placed on the wound

LAPAROSCOPIC LADD PROCEDURE

• A small incision was made to the depth of the umbilicus into

which a tiny camera was placed.
• ____Small incisions made on the abdomen
• Duodenal/jejunum/ ileum obstruction was present
• Peritoneal bands were crossing the duodenum
/jejunum/ileum/gall bladder/liver
• Ligated the peritoneal bands them with careful attention to
protecting the superior mesenteric vessels.
• Extrinsic obstruction was found due to the caecum,/ colon,
/SMA impinging on the duodenum;
• Relief is obtained by placing the caecum with its mesentery in
the left upper quadrant and exposing the anterior duodenum
through its entire length.
• Nasogastric tube was passed though the duodenum and
obstruction was not found.
• Appendectomy –was done due to normal anatomical
placement of the appendix is disrupted

FINDINGS:

• Mid gut vulvulus was founded

• Duodenal/jejunal/ ileul obstruction was founded
• Gangrenous bowel was founded from_____

AFTER PROCEDURE:

• Observe pulse rate, heart rate respiratory rate and rhythm.

• Observe temperature.

DURATION
 _________hr

POSTOPERATIVE CARE

• Administer rapid infusions of volume expanders

• Continue broad-spectrum antibiotics
• NG tube decompression is typically required
• Patients require central venous catheter access for total
parenteral nutrition until full oral feedings can be reestablished.
• Give iron supplements for anemia
• Take pain medications prescribed
• Observe for in discharge from suture site
• Surgical wound dressings will be kept clean and dry
• Start oral feeding after _____hrs

COMPLICATIONS

• Short-bowel syndrome
• Infection
• Reoperation
• Volvulus of the cecum
• Recurrence of midgut volvulus
• Bowel obstruction due to adhesions
• Insertion of central venous catheter
• Abdominal wall cyst
• Wound dehiscence
• Constipation
• Intractable diarrhea
• Abdominal pain
• Vomiting
• Feeding difficulties

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