VIDEO VIGNETTE The Ladd Procedure for Adult Malrotation With Volvulus 1 1 2 Justin T. Brady, M.D. • Daniel E. Kendrick, M.D. • Edward M. Barksdale, M.D. Harry L. Reynolds, M.D. 1 Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio 2 Division of Pediatric Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio ntestinal malrotation is a rare condition that develops the paraduodenal sac taken down. The bowel was detorsed during fetal development because of incomplete intes- and further adhesive bands divided. The duodenum was Itinal rotation or a lack of intestinal rotation around the fully mobilized from the hernia sac, and the peritoneum overlying mesentery was divided to widen the root of the superior mesenteric artery. Presentation in adulthood, in small-bowel mesentery. The duodenum was then fully ko- general, is abnormal and presentation with volvulus is rare. cherized. Although appendectomy is typically performed We demonstrate an open Ladd procedure with inversion in an adult, the patient had a thin mesoappendix, making appendectomy and reduction of paraduodenal hernia of inversion appendectomy feasible, and thus avoiding entry an adult with malrotation with volvulus. Although laparo- into the GI tract. Following inversion appendectomy, the scopic repairs have been described, because of the anticipat- small bowel was placed on the right side of the abdomen, ed difficulty in reducing the volvulus, challenging anatomy, and the colon was placed on the left side of the abdomen. and the need to establish adhesions, an open approach is The patient had an uneventful postoperative recovery. See preferred. Following diagnosis by computed tomography Video at http://links.lww.com/DCR/A537. enterography, the patient was brought to the operating room for elective repair. After entering the abdomen, there was evidence of a small-bowel volvulus involving a para- duodenal sac. The a dhesive Ladd bands were divided and KEY WORDS: Malrotation; Volvulus. Supplemental digital content is available for this article. Direct URL ci- tations appear in the printed text, and links to the digital files are pro- vided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com). Financial Disclosures: None reported. Presented at the meeting of The American Society of Colorectal Sur- geons, Seattle, WA, June 10 to 14, 2017. Correspondence: Harry L. Reynolds, M.D., Associate Professor of Surgery, University Hospitals Cleveland Medical Center, Division of Colorectal Surgery, 11100 Euclid Ave, Cleveland, OH 44106-5047. E-mail: Harry.Reynolds@UHhospitals.org Dis Colon Rectum 2018; 61: 410 DOI: 10.1097/DCR.0000000000000998 © The ASCRS 2018 DISEASES OF THE COLON & RECTUM VOLUME 61: 3 (2018) Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited.
Diseases of the Colon & Rectum – Wolters Kluwer Health
Published: Mar 1, 2018
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