Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
Pediatr Surg Int. 2020 Oct;36(10):1221-1225. doi: 10.1007/s00383-020-04729-6. Epub 2020 Aug 17.
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.
Case note review of all infants in whom laparoscopy was performed during 2016-2020 to investigate for possible malrotation.
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.
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.
我们报告了在诊断婴儿旋转不良时使用诊断性腹腔镜检查替代剖腹手术的情况，这些婴儿具有旋转不良的临床特征，且上消化道造影检查结果不确定。
对 2016 年至 2020 年期间因疑似旋转不良而行腹腔镜检查的所有婴儿的病历进行回顾性分析。
共确定了 8 名婴儿。所有婴儿均表现为旋转不良的急性临床特征（胆汁性呕吐），但无其他解释性诊断的证据。所有婴儿均行上消化道造影检查，其中 3 例还行腹部超声检查。影像学检查不能排除旋转不良，所有婴儿均行腹腔镜检查。腹腔镜检查时，检查小肠以排除中肠扭转的存在。在 6 例中，确认了正常的旋转，未发现异常病理。2 例婴儿进一步行剖腹手术，并进行了旋转不良的矫正。所有婴儿均康复，无并发症。
对于急性表现且影像学不能明确排除肠旋转不良的婴儿，腹腔镜检查是进一步检查的极好方法。DJ 袢和盲肠位于正确的解剖位置并固定在后腹壁上，这一阳性发现充分表明发生扭转的风险较低，可避免进行全腹腔镜手术。我们建议对不确定的上消化道造影检查结果进行诊断性腹腔镜检查。
