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Pediatric Surgery International

Published in:

01-10-2020 | Laparotomy | Original Article

Diagnostic laparoscopy to exclude malrotation following inconclusive upper gastrointestinal contrast study in infants

Authors: K. Sloan, A. Alzamrooni, F. E. Stedman, O. Ron, N. J. Hall

Published in: Pediatric Surgery International | Issue 10/2020

Abstract

Purpose

We report the use of diagnostic laparoscopy as an alternative to laparotomy in the investigation of infants with clinical features concerning for malrotation and inconclusive upper gastrointestinal contrast study.

Method

Case note review of all infants in whom laparoscopy was performed during 2016–2020 to investigate for possible malrotation.

Results

Eight infants were identified. All presented with acute clinical features of malrotation (bilious vomit) without evidence of an alternate explanatory diagnosis. All underwent upper gastrointestinal contrast study, with three also undergoing abdominal ultrasound. The radiological examinations could not exclude malrotation and all proceeded to laparoscopy. At laparoscopy, the small intestine was run to exclude the presence of midgut volvulus. In six cases, normal rotation was confirmed and no abnormal pathology was found. Two proceeded to laparotomy and underwent correction of malrotation. All infants recovered without complication.

Conclusion

Laparoscopy is an excellent modality for further investigation of infants presenting acutely in whom intestinal malrotation cannot be formally excluded radiologically. The positive identification of the DJ flexure and cecum in correct anatomical sites, both fixed to the posterior abdominal wall, provides adequate reassurance of low risk of volvulus and avoids a full laparotomy. We recommend diagnostic laparoscopy in cases of inconclusive upper gastrointestinal contrast study.

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Title: Diagnostic laparoscopy to exclude malrotation following inconclusive upper gastrointestinal contrast study in infants
Authors: K. Sloan
A. Alzamrooni
F. E. Stedman
O. Ron
N. J. Hall
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Laparotomy
Laparoscopy
Laparotomy
Published in: Pediatric Surgery International / Issue 10/2020
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04729-6

At a glance: The STEP trials

Springer Medicine

Diagnostic laparoscopy to exclude malrotation following inconclusive upper gastrointestinal contrast study in infants

Abstract

Purpose

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

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