Case Description Case Solution

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Michaela Kirschner

Thomas Agius S. Christen

Jeremy Meyer

Corinne Landa

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CHUV Lausanne

Clarunis Basel

HUG Genève

HFR Fribourg

Centre hospitalier du Valais romand, Sion Inselspital Bern Kantonsspital Graubünden Chur

Auflösung der Frage von S. 13

Images in Surgery

Case Solution:

The correct answer is: Ladd’s procedure.

This young patient presented with an intestinal volvulus due to congenital intestinal malrotation. The most important clue in the history were the multiple operations in early childhood, which narrowed the differential diagnosis to a congenital condition. The imaging is typical for a volvulus. The CT showed a whirl sign and a transposition of the superior mesenteric artery to the right of the superior mesenteric vein (Image A) and a transposition of the cecum in the left hemi abdomen and the small bowel predominantly on the right (Image B). We took the patient for emergency surgery. Upon entering the abdomen, we found a small bowel volvulus without intestinal ischemia, gangrene or perforation. We detorsed the bowel and divided adhesive Ladd bands. To widen the root of the mesentery and prevent further episodes of intestinal volvulus, we divided the peritoneum overlying the root of the small bowel mesentery. At the end of the operation, we placed the small bowel on the right side of the abdomen and the colon on the left side. The postoperative course was uneventful and the patient was doing well without any complaints at his last postoperative visit two months after the surgery. Intestinal malrotation is the result of an arrest of normal rotation of the embryonic gut around the axis of the superior mesenteric artery. Abnormalities Die vollständige Liste finden Sie auf unserer Homepage: swiss-knife.org

of the intestinal rotation result in a narrow base of the mesentery and, in the case of malrotation, in peritoneal bands crossing the duodenum and fixing the cecum to the right lateral abdominal wall (Ladd bands). Intestinal malrotation affects approximately one out of 6000 live births. The majority of the patients present early during infancy and before the age of one but patients can become symptomatic up to their adult live. The imaging of choice in hemodynamically stable patients is an upper GI series, which shows a displaced duodenum and obstruction if a volvulus is present. Recurrence after operative repair, as in our patient, is relatively uncommon but happens in up to 10% of patients.

Sicherheit durch Sichtbarkeit

OPSITE ◊ POST-OP VISIBLE ist ein postoperativer Wundverband mit einem einzigartigen, wabenförmigen Schaumstoffkissen und einer transparenten Folie.

Der postoperative Wundverband OPSITE ◊ POST-OP VISIBLE erlaubt dank einzigartigem wabenförmigen Wundkissen den direkten Blick auf die Wunde – ohne Verbandwechsel. Die bakteriendichte, hoch atmungsaktive Folie verhindert das Eindringen von Keimen (auch MRSA) und bildet einen wirksamen Schutz vor Sekundärinfektionen. 1,2,3

OPSITE ◊ POST-OP VISIBLE Wasser- und bakteriendichter Verband mit transparentem Wundpad

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