Sunday, July 23, 2017

Pediatric Surgery Malrotation Midgut

Malrotation of Midgut
Definition
In an incomplete rotation of the bowel during early development of the baby leading to:
   Short and narrow base of the mesentery, resulting in frequent to volvulus
   Duodenal obstruction due to the abnormal fibrous bands stretched across it from the parieties to the colon.
Objectives
   To release the fibrous bands (Bands of Ladd) in front of the duodenum
   Widen the base of the mesentery to prevent volvulus.
Position
Supine.
Anesthesia
General with endotracheal intubation.
Procedure
1.  Right transverse upper abdominal incision—5 cm long.
2.  Divide the subcutaneous tissue and muscles.
3.  Retract the liver superiorly.
4.  Identify and divide the fibrous bands in front of the duodenum with cautery.
5.  Release the small bowel to make the duodenum and the jejunum in one line and wider the base of the mesentery.
6.  Check the free flow of air from the stomach to the jejunum.
7.  Place the small bowel in the right abdomen.
8.  Place the large bowel to the left side of abdomen.
9.  Close the abdominal wound in layers.
Instruments
General pediatric set.
Sutures
   Catgut       4/0
   Silk             4/0

   Nylon                     5/0

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