A 4-day-old term neonate vomits bile-stained material after every feed. The abdomen is only mildly distended and there is minimal tenderness. An upper gastrointestinal contrast study shows a spiralled (corkscrew) duodenum with the duodenojejunal flexure to the right of the midline. What is the correct next step?

• A Elective repair at 6 months of age if symptoms persist
• B Barium enema to confirm caecal position before any operation
• C Trial of nasojejunal feeding for 48 hours
• D Urgent laparotomy with Ladd's procedure ✓

Explanation

Malrotation with midgut volvulus presents in the first weeks of life with bilious vomiting; the corkscrew duodenum on upper GI contrast study is diagnostic. Volvulus around the narrow mesenteric pedicle can strangulate the entire midgut within hours, so the correct action is prompt surgery. Ladd's procedure divides Ladd's bands, widens the mesentery, and appends the caecum to the left flank.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.