A 3-week-old male infant presents with bilious vomiting and distress. Upper GI contrast study shows the duodenojejunal junction (DJ flexure) to the right of the vertebral column and the small bowel loops predominantly in the right abdomen (malrotation). The condition known as midgut volvulus complicates malrotation. The surgical procedure to correct malrotation and reduce volvulus is the Ladd's procedure. Which step of Ladd's procedure specifically broadens the mesenteric base to prevent re-volvulus?

• A Placement of the small bowel on the right and colon on the left (counterclockwise rotation)
• B Appendicectomy
• C Division of adhesions between the duodenum and the retroperitoneum, straightening the duodenum
• D Division of Ladd's bands (peritoneal attachments between caecum and the right abdominal wall) ✓

Explanation

Ladd's procedure comprises: (1) Untwisting the volvulus counterclockwise; (2) Division of Ladd's bands — abnormal peritoneal bands that run from the caecum across the duodenum to the right upper quadrant, which also narrows the mesenteric base. Dividing Ladd's bands broadens the narrow mesenteric pedicle and frees the duodenum, which is the key step preventing re-volvulus by widening the distance between the SMA origin and the attachment of the small bowel mesentery. The bowel is then placed with small bowel on the right and large bowel on the left. Appendicectomy removes the appendix from an abnormal position (left sided).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.