Obstruction malrotation

Question 1

Malrotation

Answer 1

Cause <5 of intestinal obstruction

Question 2

When we diagnosed malrotation

Answer 2

50-70 ٪؜during neonatal period

Question 3

Malrotation associated with:

Answer 3

• Gastroschisis and omphalocele (exomphalos)
• Diaphragmatic hernia
• Duodenal atresia and biliary atresia
• Intussusception (Waugh’s syndrome)
• Dysmotility and pseudo-obstruc

Question 4

The commonest variant of malrotation :

Answer 4

• failure of the final 90°anticlockwise rotation taking the cecum from the right upper quadrant to the right iliac fossa.
• Cecum is fixed to the retroperitoneum by peritoneal bands running anteriorly to the second part of duodenum (Lad

Question 5

Cecum is fixed to the retroperitoneum by

Answer 5

Ladd band

Question 6

• The key pathology

Answer 6

The distance between the two ends of the small bowel mesentery (i.e., distance between DJ

junction and IC valve).

àwhen diminished, then risk of volvulus increases.

Question 7

Most common clinical features

Answer 7

Bile vomiting in infants

Question 8

What the cause of bile vomiting

Answer 8

Duodenum obstruction

Extrinsic : Ladd band volvouls

Question 9

Investigations

Answer 9

Abdominal x ray

Upper gi contrast

Question 10

Gold Standard investigation

Answer 10

Upper GI contrast study

Question 11

Chronic midgut volvulus

Answer 11

mesenteric thickening, with

lymphatic obstruction leading to chylous ascites and malabsorption

Question 12

Management If volvulus

Answer 12

Urgent laparotomy .

Question 13

Outcome and Complications of Ladd surgery

Answer 13

Midgut infarction (<5%)

• Recurrence of midgut volvulus post-Ladd’s procedure (<2%)
• Adhesional intestinal obstruction (5%)