Malrotation and Volvulus with Trinity
With Dr. Steve Rothenberg · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The key to this operation is to operate in front of the camera and run the bowel in front of the camera instead of chasing the bowel around the abdomen, which prevents disorientation and allows the surgeon to keep a clear view.
It is critical that the bowel be completely run from the duodenojejunal junction all the way to the ileocecal valve to ensure that all bands have been released.
The key to this operation is making sure that the mesentery has been broadly widened to prevent a twist in the future.
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.
A 12-year-old female presented with a three-month history of intermittent pain and weight loss with acute worsening of symptoms.
CT scan showed evidence of midgut volvulus.
Patient was positioned in dorsal lithotomy position with surgeon positioned between patient's legs.
5 millimeter ports were used for the procedure.
Upon entering abdomen, there was clear disorientation of the bowel with an internal hernia and complete twist of the bowel.
The anatomy was confusing because of 360-degree twist of the bowel as well as the internal hernia.
The superior mesenteric vessels were engorged because they had been twisted.
Running the bowel from proximal to distal places all the small bowel on the patient's right and the colon on the patient's left.
Using a 5mm stapler for appendix division allows keeping all ports at 5mm and not upsizing to a 12mm port for a larger stapler.
The operation took approximately 90 minutes and the patient did well.