ABSTRACT

MIDGUT MALROTATION AND LADD’S BAND CAUSING

STENOSIS OF THE DUODENUM
Eny Sanre1, Sulmiati2
Pediatric Radiology Fellowship, Radiology Department, Medical Faculty of Hasanuddin University1
Division of Pediatric Surgery, Surgery Department, Medical Faculty of Hasanuddin University2

Background
Duodenal stenosis is incomplete duodenal obstruction due to failure to form billiar and
pancreatic structures or malrotation of the digestive system during fetal period (> 20%). The late
diagnosis and management in this case will provide a poor prognosis and even death. The
Ladd’s procedure is the best management for malrotation cases

Objective
To illustrate a stenosis of duodenum due to malrotation midgut in children can be
assessed through history taking, physical examination, laboratory assessment, and
radiography

Methods
Radiology examination uses plain abdominal photographs, Ultrasonography, Upper
gastrointestinal series, Barium contrast, and CT Scan with contrast

Results
Boys aged 7 days were referred to RSUP Dr Wahidin Sudirohusodo with a diagnosis of
suspious Congenital Hypertrophy Pyloric Stenosis. From alloanamnesis, patients often vomited
green every +/- 3 hours after being given milk. From physical examination, patients appear
passive, anemic and jaundice.
Laboratory results obtained an increase in WBC. Ultrasound examination before entering
RSUP Dr Wahidin Sudirohusodo is within normal limits. Plain abdominal radiographs were
obtained distended on the stomach, examination of maag duodenography showed a picture of
duodenal stenosis.
Laparotomy is then performed and a gastric and duodenal dilatation is obtained, the ligamentum
Treitz is located in the right upper quadrant, band entrapment of the duodenum to ileum,
appendix and cecum located in the upper right, impression of Midgut Malrotation, Ladd’s band
procedure is decided. A week after surgery, symptoms of duodenal obstruction are reduced and
the patient appears more active

Discusion
The findings of duodenal stenosis due to band entrapment in recent years have often been
reported. Ladd’s band procedure is the best treatment option for this case. With the
advancement of imaging radiology, this condition can be found earlier even during
antenatal pregnancy.

Conclution
Surgical correction of Duodenal obstruction is not urgent, it can take place once the infant is
optimized hemodynamically and associated anomalies have been appropriately studied.

Keywords : Green vomiting, band bondage, Radiology imaging, Ladd procedure