Sudha Ayyala Anupindi MD, Abstract Co-Author: Nothing to Disclose

Stephanie Beale Hanhan MD, Presenter: Nothing to Disclose

Richard Ira Markowitz MD, Abstract Co-Author: Nothing to Disclose

Thane Blinman MD, Abstract Co-Author: Nothing to Disclose

David Matthew Biko MD, Abstract Co-Author: Nothing to Disclose

Abbas Jawad PhD, Abstract Co-Author: Nothing to Disclose

Reports of recurrent volvulus in patients who have had a Ladd procedure for malrotation highlight the seriousness but rare occurrence of this complication. We questioned how often this or other complications occur and how they may be recognized clinically and radiographically.

With IRB approval we retrieved from our surgery database information on 165 patients [94 males, 71 females, age at surgery average 3.9 years (range 0 days – 26.9 years)] who underwent a Ladd procedure for malrotation from Jan. 2002 - Dec. 2008. 48 patients with false positive pre-surgical upper GI’s, heterotaxy, congenital diaphragmatic hernia or anterior abdominal wall defects were excluded resulting in a study group of 117 patients. A sub-group of 37 patients returned with complications and are the focus of this study. Their records, radiographs, and upper GI examinations were reviewed.

A total of 37/117 (31.6%) patients presented with complications (mean time from surgery = 9.7 months; range: 1 day – 14.5 years). The most common clinical symptoms in this group included: vomiting (75.7%), abdominal pain (8.1%), feeding intolerance (8.1%), bloody stools (5.4%) and irritability (2.7%). One third of patients with complications had imaging signs of small bowel obstruction (dilated bowel loops, air-fluid levels, and decompressed colon). Most of the small bowel obstructions were partial and did not require additional surgery. One patient (less than 3%) had recurrent midgut volvulus. UGI provided information about the level of obstruction in a few cases. 6/37 (16%) of patients had a laparoscopic assisted Ladd procedure and 31/37 (84%) had an open Ladd procedure. There was no association between complication rate and type of surgery.

Although recurrent volvulus is one of the most deleterious post Ladd procedure complications, our data shows that it rarely occurs. Small bowel obstruction due to adhesions is far more common and in few may lead to further surgery. Upper GI study may not provide additional information over radiography, therefore it has limited utility in diagnosis.

 The post-operative complications of the Ladd's procedure for malrotation repair is rarely discussed. This paper will elucidate these findings and define the role of post-operative imaging.

Anupindi, S, Hanhan, S, Markowitz, R, Blinman, T, Biko, D, Jawad, A, Is Recurrent Volvulus a Common Complication Following the Ladd Procedure for Repair of Malrotation?.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8007110.html