Correction Of Malrotation

CORRECTION OF MALROTATION REASON FOR VISIT: • • • • • •

Midgut vulvulus Bilious vomiting Abdominal pain Abdominal distention The passage of blood and mucus in their stool Recurrent abdominal pain and vomiting

RISK ASSESSMENT • • • • •

Family history of bleeding disorders Unstable cardiovascular system Liable heat control History of bleeding disorders History of allergy to Medications Anesthesia

PREPARATION OF THE PATIENT: • • • • • • • • • • • • • •

Blood tests Urine tests Plain abdominal radiography Upper gastrointestinal series Contrast enema CT scanning Ultrasonography Preoperative antibiotics were administered to the patients with diseases of the heart valves Oral feeding was stopped for ___hrs before procedure Electrolyte imbalance, fluid imbalance, acid/base imbalance was corrected by using the intravenous infusion Nasogastric tube was placed The NG tube was adjusted to low intermittent suction in order to decompress the bowel proximal to any obstruction that may be present. Central venous catheter was placed Part was prepared draped in sterile fashion

ANESTHESIA: General anesthesia POSITION OF THE PATIENT Supine position THE PROCEDURE THE LADD PROCEDURE: Open Ladd procedure Laparoscopic Ladd procedure OPEN LADD PROCEDURE • • • • • • • • • • • • • • •

Abdominal incision was given from _________ to _____ And abdomen is opened in layer by layer The muscles were separated and blood vessels, nerves were protected Midgut vulvulus was present, the entire small intestine along with the transverse colon was delivered out of the abdominal incision The volvulus twisted in a clockwise direction, reduction was done by twisting the vulvulus in a counterclockwise direction. The blood supply was restored by detorsion Gangrenous bowel was presented from _______to_____ Gangrenous bowel was resected, and primary anastomosis was performed. Enterostomy was performed. Duodenal obstruction was present Peritoneal bands were crossing the duodenum Ligated the peritoneal bands with taking careful attention to protecting the superior mesenteric vessels. Extrinsic obstruction was found due to the caecum,/ colon, /SMA impinging on the duodenum Relief is obtained by placing the caecum with its mesentery in the left upper quadrant and exposing the anterior duodenum through its entire length. Nasogastric tube was passed though the duodenum and obstruction was not found.

• • • • •

Appendectomy –was done due to normal anatomical placement of the appendix is disrupted The peritoneum and fascia of the transversalis muscle was closed with a running absorbable suture. The remaining fascial layers were closed with the running or interrupted absorbable sutures. The skin was closed with a subcuticular absorbable suture such as Monocryl. Collodian or adhesive Steri-strips are placed on the wound

LAPAROSCOPIC LADD PROCEDURE •

A small incision was made to the depth of the umbilicus into which a tiny camera was placed. • ____Small incisions made on the abdomen • Duodenal/jejunum/ ileum obstruction was present • Peritoneal bands were crossing the duodenum /jejunum/ileum/gall bladder/liver • Ligated the peritoneal bands them with careful attention to protecting the superior mesenteric vessels. • Extrinsic obstruction was found due to the caecum,/ colon, /SMA impinging on the duodenum; • Relief is obtained by placing the caecum with its mesentery in the left upper quadrant and exposing the anterior duodenum through its entire length. • Nasogastric tube was passed though the duodenum and obstruction was not found. • Appendectomy –was done due to normal anatomical placement of the appendix is disrupted

FINDINGS: • • •

Mid gut vulvulus was founded Duodenal/jejunal/ ileul obstruction was founded Gangrenous bowel was founded from_____

AFTER PROCEDURE: • •

Observe pulse rate, heart rate respiratory rate and rhythm. Observe temperature.

DURATION

_________hr POSTOPERATIVE CARE • • • • • • • • •

Administer rapid infusions of volume expanders Continue broad-spectrum antibiotics NG tube decompression is typically required Patients require central venous catheter access for total parenteral nutrition until full oral feedings can be reestablished. Give iron supplements for anemia Take pain medications prescribed Observe for in discharge from suture site Surgical wound dressings will be kept clean and dry Start oral feeding after _____hrs

COMPLICATIONS • • • • • • • • • • • • • •

Short-bowel syndrome Infection Reoperation Volvulus of the cecum Recurrence of midgut volvulus Bowel obstruction due to adhesions Insertion of central venous catheter Abdominal wall cyst Wound dehiscence Constipation Intractable diarrhea Abdominal pain Vomiting Feeding difficulties

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