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Midgut Volvulus
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
The concept is that patients are capable of having normal growth, and as you address issues and improve something, you need reasonable follow-up time on the order of weeks, not months. — Michael Helmrath, Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient · 9:48
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
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We’re back with a new episode from the intestinal rehabilitation center at Cincinnati Children’s Hospital.
This time we’re talking about Refeeding in older patients with Drs. Helmrath and Wales.
If you are looking for refeeding a Neon
podcast12:05 · Oct 2023
Current ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma. — Todd Ponsky, Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS · 19:40
Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS
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Dr. Jose Campos and his team, Sociedad Chilena Cirugia Pediatrica curate the best pediatric surgical articles in non-core pediatric surgery journals and in this session, they describe their 5 favorites from the past year. The conversation i
video22:13 · May 2022
One should be able to see the superior mesenteric artery and vein coming straight down into the middle of the abdomen with no twists or obstruction. Malrotation and Volvulus with Trinity · 6:39
Malrotation
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Dr. Soldes discusses the classifications of malrotation through the presentation of case presentations. Discussion topics include Ladd's procedure, volvulus, non-bilious emesis, redundant duodenum, gastroesophageal reflux, and laparoscopy.
video42:31 · Nov 2018
Malrotation and Volvulus with Trinity
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Surgical technique video demonstrating laparoscopic reduction of midgut volvulus with Ladd procedure in a 12-year-old with chronic symptoms and acute obstruction. Shows systematic band division, bowel derotation, mesenteric widening, and ap
video8:02 · May 2026
Some believe part of the benefit of Ladd procedure is widening the mesentery plus causing scar tissue that helps bowel adhere in a configuration preventing midgut volvulus. — Meera Kotagal, Malrotation with Dr. Meera Kotagal · 10:01
Malrotation with Dr. Meera Kotagal
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In this podcast, we cover the basics of malrotation including embryology, presentation, differentiation, diagnosis, surgical approach, and post operative management with Dr. Meera Kotagal.
Host: Em Tombash
Animations to understand the
podcast13:25 · May 2023
Expert statements from the recordings in this collection.
Malrotation
In the first two months of life, about 70% of volvulus cases occur, and by the first two years of life, 90% of volvulus cases that are going to occur do occur
In 20% of cases with true malrotations of the fore and mid-gut, you have a normal barium enema
A normal ultrasound does not rule out volvulus, supported by multiple studies
Ladd's bands do not cause midgut volvulus
Jack4:02
Ladd's bands are thought to be an attempt of the body to fuse the cecum to the lateral peritoneal wall
Wit37:16
The key reason to operate on an asymptomatic patient is to avoid midgut volvulus
Jack3:52
The critical measurement is the distance between the ligament of Treitz and the ileocecal junction to prevent volvulus, though nobody knows the exact distance required
Jack4:56
In patients with heterotaxy syndromes who have asymptomatic malrotations and undergo operations, the complication rate is remarkably high, between 30 and 50%
In a study from Edmonton on heterotaxy patients who underwent procedures for malrotation, the complication rate was about 50%
In a study by Papillon from Children's LA of about 200 heterotaxy patients, a quarter got screening upper GIs and three quarters did nothing; in 4 years there was only one case of volvulus, and in patients without bilious emesis and symptoms, no cases of volvulus
In the heterotaxy subgroup, the risk of volvulus in the early period (4-5 years) is actually very low if patients are not symptomatic
When bowel loops are dilated, this will always give you a low-lying ligament of Treitz
Todd Ponsky11:53
Atypical malrotation with a low-lying ligament of Treitz has some data showing lower risk of volvulus, though the data is not strong
In patients with rotation abnormalities, reversed mesenteric vessels may or may not be seen; it doesn't definitively indicate malrotation
Jack41:01
In Jack's series of several hundred patients, there was never a case where the vessels were normal in a patient who had risk for volvulus (narrow base mesentery), so they use it as a screening test in sick patients
Jack41:15
Upper GI is clearly better than ultrasound for diagnosing malrotation, but in a sick patient who can't get to radiology, ultrasound can be useful
Jack41:54
Laparoscopic Ladd's procedure can be very effective even in a newborn, though if there's too much twist and no room, conversion to open may be necessary
Tim Kane8:18
In cardiac patients between first stage and Glenn procedure who get G-tubes, Nissen fundoplication is often requested because they vomit and are too small for PEGs
Tim Kane14:42
A 45-minute Nissen at pressures of 8 is tolerated by cardiac patients between stages
Tim Kane14:56
In a published study combining experience with Kansas City, the cardiac risk group did not stratify out to be at higher risk for reflux complications; neurologically impaired CP kids maybe, but not cardiac kids
Yama does not operate on asymptomatic malrotation as long as the patient has non-bilious vomiting, is gaining weight, and is clinically well
If a patient has a narrow pedicle, the patient always has vomiting and is symptomatic
Ladd's bands themselves are not risky; the risk is bilious vomiting and narrowing of the pedicle
In situs inversus or ambiguous cases, measuring the distance between ligament of Treitz and ileocecal junction matters regardless of where the bowels are; if less than half the diameter of the abdominal cavity, intervention is needed
Jack39:27
Malrotation with Dr. Meera Kotagal
Malrotation occurs in about 1 in 200 to 500 live births.
Host summaryEm Tombash summarizes what Dr. Meera Kotagal said — not the host's own clinical position0:28
In the fourth week of gestation, bowel development begins, and as the bowel grows in length it herniates into the yolk sac along the umbilical cord and SMA axis.
Meera Kotagal1:17
Normal rotation involves a 90-degree rotation of the duodenal-jejunal loop, then return of bowel with 270-degree rotation of cecum and colon, resulting in duodenal-jejunal junction to the left of midline at ligament of Treitz and cecum in right lower quadrant.
Meera Kotagal1:44
Intestinal rotation abnormalities fall along a spectrum rather than being simply normal or abnormal, including both non-rotation and malrotation.
Meera Kotagal2:22
In non-rotation, the gut returns without rotating, resulting in colon on the left and small bowel on the right, without the problematic Ladd bands that cause obstruction in malrotation.
Meera Kotagal2:22
Non-rotation anatomy looks similar to the anatomy of a malrotated patient post-Ladd procedure.
Meera Kotagal2:22