Before offering surgery to the
patient for intestinal malrotation,
we need to do some preoperative planning.
We have to offer the
patient supportive care
to correct the electrolyte abnormalities
and restore the patient's
They are very likely
to be dehydrated
from the volume of emesis.
Let's talk about a classic procedure
called the Ladd’s procedure.
This is the procedure that is
known to fix malrotation patients.
At the time of an exploratory laparotomy,
you want to assess
whether or not
the intestines are actually viable.
during a clinical scenario presented to you,
if there's any signs that
the bowel is ischemic,
that ischemic segment
needs to be resected.
During a Ladd’s procedure,
we first eviscerate all the intestines.
Then we detorse the intestines
usually in a counterclockwise direction.
Next, we divide the duodenal bands
called the Ladd’s bands.
Remember, the duodenojejunal junction
is now attached to the right
upper quadrant of the abdomen
and that is abnormal.
And we always do an appendectomy.
because the cecum is not in
the right lower quadrant of the abdomen
in malrotation patients,
appendicitis later on as
a diagnosis can be difficult.
I’d like to pose a question to you.
What if the child has
or is progressively lethargic?
I’ll give you a second
to think about this.
Take the patient to
the operating room.
This patient is demonstrating failure to thrive
and potentially ischemic intestines.
Particularly with hypotension,
it may be indication of septic shock.
In babies, we use dopamine.
Again, a clinical scenario that presents
the patients as deteriorating,
who initially was not peritoneal,
take the patient to the operating room.
Let's visit some important clinical pearls
and high-yield information
for intestinal malrotation.
Malrotation is considered a surgical emergency.
Don't sit on these patients.
replace the electrolytes
and take the patient
to the operating room.
by the time you’ve taken
the patient to the operating room
that the intestines are still alive
and require no resection.
But a Ladd’s procedure
is still performed.
Remember bilious emesis in
a child is intestinal malrotation
until proven otherwise.
This is particularly important
because malrotation can
lead to ischemic bowel.
Have a high index of suspicion.
Thank you very much for joining me
on this discussion of intestinal malrotation.