LADD’S SYNDROME- Volvulus neonatorum

Question 1

Coexistent congenital anomalies

Answer 1

cardiac anomalies, bowel atresia, duodenal web, anorectal anomalies, orthopaedic anomalies) are common

Question 2

Clinical signs

Answer 2

vomiting, typically bilious, as the commonest presenting feature accompanied by colicky abdominal pain and abdominal distention.

failure to thrive, malabsorption, diarrhoea

An infant with abdominal tenderness and blood per rectum is suggestive of bowel ischaemia due to midgut volvulus.

Question 3

Ladd’s bands are

Answer 3

fibrous stalks of peritoneal tissue that attach the cecum to the retroperitoneum in the right lower quadrant (RLQ).

Question 4

Obstructing Ladd’s Bands are associated with malrotation of the intestine,

Answer 4

in which the cecum is found in the right upper quadrant (RUQ), instead of its normal anatomical position in the RLQ. Ladd’s bands then pass over the second part of the duodenum, causing extrinsic compression and obstruction.

Question 5

Treatment

Answer 5

Ladd procedure” is performed to alleviate intestinal malrotation. The procedure involves counterclockwise detorsion of the bowel, surgical division of Ladd’s bands, widening of the small intestine’s mesentery, performing an appendectomy, and reorientation of the small bowel on the right and the cecum and colon on the left (the appendectomy is performed so as not to be confused by atypical presentation of appendicitis at a later date)

Question 6

Diagnosis

Answer 6

Chest X-ray-

− This may reveal classic pattern for duodenal obstruction (the double-bubble sign) with little gas in the remainder of the intestine

Ultrasound - The main diagnostic finding is inversion of the superior mesenteric artery and the superior mesenteric vein.

Upper G.I study
− If the contrast ends abruptly or a corkscrew pattern is seen, midgut volvulus may be present

Lower gastrointestinal study:

− Contrast enema may be used to identify the location of the cecum.

− Lower gastrointestinal study can also rule out colonic and ileal atresia obstruction. However, a normally placed cecum does not rule out malrotation.