- on day old infant has vomiting and abdominal distension.baby has passed meconium.
- Bilious vomiting, usually with some abdominal distention,
occurs in a baby who passed normal meconium
and has an open anus. X-ray films may show duodenal
obstruction and usually show some gas throughout
the abdomen. - Diagnosis: Malrotation
Malrotation is the most malevolent lesion of infancy
because of its propensity toward volvulus with resultant
strangulation of the superior mesenteric artery.
This catastrophe can lead to total destruction of the
digestive-absorptive segment of the intestinal tract—
the jejunoileum. F urthermore, compared with any
other single anomaly, this lesion is quite common. I t
must, therefore, always be in the differential diagnostic
forefront to be rapidly ruled in or out. T he most direct
method for doing so is by upper gastrointestinal
contrast study, which demonstrates obstruction of
the duodenum. I f obstruction is incomplete, the study
reveals that the duodenal C loop fails to complete its
normal course to a position in the left upper quadrant
behind the stomach—the ligament of Treitz. - Contrast enemas, frequently recommended for
diagnosis of malrotation in the past, may be confusing.
T he high-riding cecum with malpositioned
appendix is diagnostic if clearly present, but often
the cecal position is equivocal and difficult to locate
clearly. R eflux of dye into the ileum may mask the position
of the cecum. - Therapeutic delay is intolerable here. O ne should quickly intervene operatively in any duodenal obstruction not clearly caused by an entity other than malrotation
Dr. Jayaprakash
Superintendent, ICH.
Institute of Child Health.
Gov. Medical College Kottayam.
Kerala, India.