LAPAROSCOPIC EVALUATION AND TREATMENT OF INTESTINAL MALROTATION IN INFANTS

Infants with intestinal malrotation present with bilious emesis and th e diagnosis is generally obtained by an upper gastrointestinal barium study. Malrotation is suspected if the ligament of Treitz is not posit ioned to the left of the vertebral body. Barium enema may also be used to detect malrotation by noting the abnormal position of the cecum fr om its usual placement in the right lower quadrant, but this study is not as reliable due to the mobility of the cecum. Some infants may not have classic radiographic findings for malrotation, yet the contrast studies are not entirely normal. We recently treated two infants with recurrent vomiting whose UGI studies suggested intestinal malrotation. Laparoscopic exploration confirmed the diagnosis of malrotation. Lapa roscopic correction (Ladd's procedure) of malrotation was carried out in one infant. The second infant underwent a traditional Ladd's proced ure. The technique of laparoscopic Ladd's procedure is described. Lapa roscopy may be used for the diagnosis and treatment of infants with in testinal malrotation. It may be especially helpful to verify the diagn osis in patients who do not have classic radiographic findings. Whethe r laparoscopy should be used in patients with midgut volvulus is debat able. Laparoscopic derotation of the volvulus in a setting where the b owel is markedly distended may be difficult and dangerous.