Gross E, Chen M K, Lobe T E
Section of Pediatric Surgery, LeBonheur Children's Medical Center, University of Tennessee, Memphis 38105, USA.
Surg Endosc. 1996 Sep;10(9):936-7. doi: 10.1007/BF00188488.
Infants with intestinal malrotation present with bilious emesis and the diagnosis is generally obtained by an upper gastrointestinal barium study. Malrotation is suspected if the ligament of Treitz is not positioned to the left of the vertebral body. Barium enema may also be used to detect malrotation by noting the abnormal position of the cecum from its usual placement in the right lower quadrant, but this study is not as reliable due to the mobility of the cecum. Some infants may not have classic radiographic findings for malrotation, yet the contrast studies are not entirely normal. We recently treated two infants with recurrent vomiting whose UGI studies suggested intestinal malrotation. Laparoscopic exploration confirmed the diagnosis of malrotation. Laparoscopic correction (Ladd's procedure) of malrotation was carried out in one infant. The second infant underwent a traditional Ladd's procedure. The technique of laparoscopic Ladd's procedure is described. Laparoscopy may be used for the diagnosis and treatment of infants with intestinal malrotation. It may be especially helpful to verify the diagnosis in patients who do not have classic radiographic findings. Whether laparoscopy should be used in patients with midgut volvulus is debatable. Laparoscopic derotation of the volvulus in a setting where the bowel is markedly distended may be difficult and dangerous.
患有肠旋转不良的婴儿会出现胆汁性呕吐，通常通过上消化道钡剂造影来进行诊断。如果Treitz韧带未位于椎体左侧，则怀疑存在旋转不良。钡剂灌肠也可用于检测旋转不良，通过观察盲肠相对于其正常位于右下腹的位置异常来判断，但由于盲肠的活动度，这项检查不太可靠。一些婴儿可能没有旋转不良的典型影像学表现，但对比检查也并非完全正常。我们最近治疗了两名反复呕吐的婴儿，他们的上消化道造影提示肠旋转不良。腹腔镜探查证实了旋转不良的诊断。其中一名婴儿接受了腹腔镜下旋转不良矫正术（Ladd手术）。第二名婴儿接受了传统的Ladd手术。本文描述了腹腔镜Ladd手术的技术。腹腔镜可用于肠旋转不良婴儿的诊断和治疗。对于没有典型影像学表现的患者，它在核实诊断方面可能特别有帮助。对于中肠扭转患者是否应使用腹腔镜存在争议。在肠明显扩张的情况下，腹腔镜下扭转复位可能困难且危险。
