A 3-day-old term neonate feeds normally then develops sudden bilious vomiting and abdominal distension. Abdominal radiograph shows a gasless lower abdomen with a few dilated proximal loops and a double bubble-like configuration. Upper GI contrast study reveals the duodenojejunal flexure lying to the right of the midline and the caecum in the epigastrium. Definitive treatment involves division of which structures?

• A Hypertrophied pyloric muscle
• B Ladd's bands crossing the duodenum ✓
• C Congenital duodenal web at the ampulla
• D Meckel's diverticulum band to the umbilicus

Explanation

Malrotation with midgut volvulus presents in the first days of life with bilious vomiting. An abnormal relationship of the duodenojejunal flexure and caecum confirms malrotation; the gut hangs on a narrow mesentery predisposing to clockwise volvulus. Ladd's operation divides Ladd's bands compressing the duodenum, widens the mesenteric base, and places the bowel in non-rotated position. Pyloric stenosis gives non-bilious projectile vomiting, and a duodenal web is a fixed intrinsic obstruction without volvulus risk.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.