Chapter 67 / Pediatric Surgery 547
What are Ladd’s bands? Fibrous bands that extend from the abnormally placed cecum in the RUQ, often crossing over the duodenum and causing obstruction
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Ladd’s |
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bands |
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7 |
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‘0 |
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HRF |
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What is the usual age at |
33% are present by 1 week of age, 75% |
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onset? |
by 1 month, and 90% by 1 year |
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What is the usual |
Sudden onset of bilious vomiting (bilious |
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presentation? |
vomiting in an infant is malrotation |
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until proven otherwise!) |
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Why is the vomiting bilious? |
“Twist” is distal to the ampulla of Vater |
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How is the diagnosis made? |
Upper GI contrast study showing cutoff |
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in duodenum; BE showing abnormal |
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position of cecum in the upper abdomen |
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What are the possible |
Volvulus with midgut infarction, leading to |
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complications? |
death or necessitating massive enterectomy |
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(rapid diagnosis is essential!) |
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What is the treatment? |
IV antibiotics and fluid resuscitation with |
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LR, followed by emergent laparotomy with |
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Ladd’s procedure; second-look laparotomy |
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if bowel is severely ischemic in 24 hours to |
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determine if remaining bowel is viable |
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548 Section III / Subspecialty Surgery |
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What is the Ladd’s |
1. |
Counterclockwise reduction of |
procedure? |
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midgut volvulus |
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2. |
Splitting of Ladd’s bands |
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3. |
Division of peritoneal attachments to |
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the cecum, ascending colon |
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4. |
Appendectomy |
In what direction is the |
Rotation of the bowel in a |
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volvulus reduced—clockwise |
counterclockwise direction |
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or counterclockwise? |
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Where is the cecum after |
LLQ |
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reduction? |
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What is the cause of bilious |
Malrotation with midgut volvulus |
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vomiting in an infant until |
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proven otherwise? |
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OMPHALOCELE |
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What is it? |
Defect of abdominal wall at umbilical |
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ring; sac covers extruded viscera |
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How is it diagnosed |
May be seen on fetal U/S after 13 weeks’ |
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prenatally? |
gestation, with elevated maternal AFP |
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What comprises the “sac”? |
Peritoneum and amnion |
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What organ is often |
The liver |
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found protruding from |
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an omphalocele, but is |
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almost never found with a |
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gastroschisis? |
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What is the incidence? |
1 in 5000 births |
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How is the diagnosis made? |
Prenatal U/S |
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What are the possible |
Malrotation of the gut, anomalies |
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complications? |
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What is the treatment? |
1. |
NG tube for decompression |
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2. |
IV fluids |
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3. |
Prophylactic antibiotics |
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4. |
Surgical repair of the defect |
Omphalocele