Ladd’s band in the adult, an unusual case of occlusion: Case report and review of the literature

Grassi, C; Conti, Luigi; Palmieri, Gerardo; Banchini, Filippo; Daccò, Maria Diletta; Cattaneo, G; Capelli, Patrizio

doi:10.1016/j.ijscr.2020.04.046

Cited by 12 publications

(17 citation statements)

References 18 publications

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“…Intestinal malrotation or incomplete common mesentery is caused by the partial or complete failure of 270 degrees' counterclockwise rotation of the midgut around superior mesenteric vessels in fetal life [4] . Embryologically, it is malrotation and joining of the primitive intestine that is causing the incomplete common mesentery [1] , so the root of the mesentery is very short, and the whole small intestine is located on the superior mesenteric artery axis [2] , the peritoneal fibrous band – also known as Ladd's band –can compress duodenum causing a duodenal obstruction [4] . Intestinal malrotation is a disease of the newborn as it frequently manifests in the first month of life; adult manifestation is very rare [4] .…”

Section: Discussionmentioning

confidence: 99%

“…Embryologically, it is malrotation and joining of the primitive intestine that is causing the incomplete common mesentery [1] , so the root of the mesentery is very short, and the whole small intestine is located on the superior mesenteric artery axis [2] , the peritoneal fibrous band – also known as Ladd's band –can compress duodenum causing a duodenal obstruction [4] . Intestinal malrotation is a disease of the newborn as it frequently manifests in the first month of life; adult manifestation is very rare [4] . Acute intestinal obstruction and enteromesenteric infarction are the main life-threatening complications of incomplete common mesentery [5] , [6] .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

Jabra¹,

Chaouch²,

Moussa³

et al. 2023

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

Jabra¹,

Chaouch²,

Moussa³

et al. 2023

International Journal of Surgery Case Reports

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“…CT scan has consistently been reliable in identifying several features consistent with malrotation including; whirlpool sign, SMA/SMV abnormalities, an underdeveloped pancreas or absence of the uncinate process, and positional abnormalities of the duodenum, small intestine and cecum [4] , [5] . CT scan has been effective at diagnosing intestinal malrotation in adults with diagnostic rates between 80 and 97% [4] , [5] , [16] .…”

Section: Discussionmentioning

confidence: 99%

Variations of intestinal malrotation in adults: A case report of midgut volvulus and literature review for the surgeon

Ribeiro¹,

Greene²,

Bennett³

et al. 2022

International Journal of Surgery Case Reports

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Introduction Intestinal malrotation is a rare congenital abnormality occurring in 0.2–1% of the population. Adult presentations comprise only 0.2–0.5% of all cases leading to diagnostic challenges and worse outcomes in adults. We present a rare case of chronic/intermittent midgut volvulus with unique anatomic findings in an adult with intestinal malrotation. Presentation of case An 18-year-old Caucasian male presented to a community hospital with abdominal pain, nausea, and vomiting. He underwent a CT scan demonstrating concern for small bowel volvulus and subsequently underwent a negative exploratory laparotomy. He was discharged post-operatively with no identified etiology for his presentation. He subsequently had multiple presentations to the ED with recurrent symptoms, review of imaging led to concern for duodenal volvulus resulting in transfer to a tertiary hepatobiliary centre. Repeat CT scan two weeks following initial presentation was consistent with intestinal malrotation with midgut volvulus. Bloodwork was unremarkable and physical exam demonstrated normal vital signs with a tender epigastrium. He underwent an exploratory laparotomy with Ladd's procedure. Intra-operative findings included a midgut volvulus and uniquely positioned Ladd's bands to the transverse colon. Post-operatively he tolerated oral intake and was discharged with three-month follow-up. Discussion Adults with intestinal malrotation suffer from delays in diagnosis and management. In contrast to the neonatal population, adults often present with vague, or chronic symptoms, which obscures the diagnosis. Conclusion The increased morbidity and mortality observed in adults with intestinal malrotation highlights the need for surgeons to appreciate the challenges associated with this diagnosis in the adult population to ensure early recognition and management.

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“…Malrotation of the gut is due to complete or partial failure of 270 degree of clockwise rotation of the midgut around the superior mesenteric pedicle; it results in the anomalous position of small bowel loops in the right side with absence of ligament of Treitz and appendix, caecum and ascending colon on the left side. 3 Malrotation is commonly diagnosed in infancy with a 55% incidence of a clinical emergency related to malrotation in the first week of life and an 80% incidence within the first month of life. 4 A peritoneal fibrous band - also known as Ladd's band can compress duodenum causing the duodenal obstruction.…”

Section: Discussionmentioning

confidence: 99%

A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

et al. 2020

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Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd’s band was diagnosed based on clinical acumen, high- resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd’s procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd’s band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.

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Ladd’s band in the adult, an unusual case of occlusion: Case report and review of the literature

Cited by 12 publications

References 18 publications

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

Variations of intestinal malrotation in adults: A case report of midgut volvulus and literature review for the surgeon

A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

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