Laparoscopic Reduction of Acute Midgut Volvulus and Ladd’s Procedure in a 2.6kg Neonate

Megan E. Cunningham, MD; Caitlin S. Hoover, PA-C; Caroline V. Hornberger, PA-C; Sohail R. Shah, MD, MSHA, FACS

Product Details
Product ID: ACS-5638
Year Produced: 2018
Length: 5 min.


The patient is a 2.6 kg, 7-day old male, born vaginally after induction at 37-weeks gestation due to preeclampsia. Hospital course post-delivery was routine and the neonate was sent home on day-of-life two. He presented five days later with two days of emesis after tolerating breast milk. Emesis severity increased over time and became bilious. Physical exam was benign. A fluoroscopic upper gastrointestinal series showed minimal motility of the duodenum that formed a corkscrew configuration to the right of the left spinal pedicle; classic for malrotation and midgut volvulus. The patient was taken to the operating room within the hour. General anesthesia was induced and the abdomen was entered at the umbilicus where a 5mm trocar was placed. Three-millimeter incisions were made for instrumentation in the left lower and upper quadrants and suprapubic region. The bowel was visualized as dusky, but not necrotic. The cecum and appendix were identified in the right upper quadrant (RUQ). The small bowel was run proximally until it tightened and dipped posterior to the mesentery. The bowel was untwisted counterclockwise and immediately pinked. Ladd's bands in the RUQ were identified and lysed until the mesentery was widely splayed. The small bowel was moved to the right abdomen and the colon to the left. An appendectomy was performed by suture ligation and electrocautery through the umbilical incision. The umbilical port site was closed with an absorbable suture. The postoperative course was without incident and the neonate was tolerating full feeds without emesis prior to being discharged.