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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