Ladd’s procedure for malrotation and volvulus factsheet
Introduction
During the first trimester of pregnancy, a baby’s bowel forms as a long tube that connects the stomach to the anus. As it grows, the bowel moves into the umbilical cord, where there is more space. It then moves back into the belly and coils into place.
Malrotation happens when the bowel doesn’t turn properly during this process.
The cause is unknown. It affects about 1 in 200 babies but only causes problems in 1 in 6000 cases.
Volvulus is a serious condition where the bowel twists and cuts off its blood supply. This can make your baby severely unwell and is a medical emergency.
Babies born with a malrotation are more likely to develop volvulus, especially in the first month of life.
Signs and symptoms
Malrotation may not cause symptoms unless a volvulus develops.
Volvulus is a medical emergency. A baby can look very well and still have a volvulus. If your baby has any of the above symptoms, it is important that you see a doctor urgently as their bowel may already be in trouble.
Signs of a volvulus in your baby include:
- blood in their poo
- pooing less than usual
- fast breathing
- fast heart rate
- irritability and being difficult to settle
- being very sleepy or floppy
- fever
- tummy pain that makes them cry and pull up their legs
- bilious vomiting - vomiting green liquid.
If your baby starts to vomit green liquid, this may mean they have a blocked bowel. Call triple zero (000) for an ambulance or attend your nearest emergency department immediately.
Diagnosis
Your baby’s doctor will diagnose a malrotation and volvulus based on:
- results from a contrast study
- your baby’s symptoms.
Contrast study
In a contrast study, your baby is given a special dye through a nasogastric (NG) tube that goes through their nose, into their stomach.
The dye will show up on X-rays, helping the doctor see how the bowel is working.
Treatment
Malrotation and volvulus are treated with:
- fluids
- antibiotics
- urgent surgery to correct the twist in the bowel.
Ladd’s procedure
Surgery to correct a malrotation and volvulus is called a Ladd’s procedure. This procedure must be done quickly, as the bowel may already be damaged and dying.
The risks of not doing surgery are much higher than the risks of the operation.
Risks of surgery can include:
- needing a blood transfusion
- damage to nearby organs like the liver
- wound infection
- scar tissue causing blockages later in life
- problems absorbing nutrients if a large part of the bowel is removed.
This surgery is done under a general anaesthetic, which means your baby will be asleep.
Your baby may go straight from the emergency department to surgery. The treatment team will talk with you and answer any questions.
During the Ladd’s procedure
During the Ladd’s procedure:
- a cut is made above the belly button
- the surgeon cuts any tissue that is holding the bowel in the wrong place
- if the bowel is healthy, it is moved to a safe position
- if parts of the bowel are dead, they are removed while keeping as much of the healthy bowel as possible
- healthy parts of the bowel are joined back together
- if the bowel cannot be joined, a stoma may be created to help the bowel recover
- the cut is closed with stitches or left open with a dressing if another surgery is needed in the next few days.
Sometimes the appendix is also removed if it is sitting in the wrong place. This is safe to do and helps avoid problems later.
After the Ladd’s procedure
Your baby may need time to recover in the intensive care unit (PICU). They may need a breathing tube and will get pain relief, fluids and nutrition through an intravenous (IV) cannula.
Your baby’s treatment team will help you return to breastfeeding or bottle feeding slowly.
Stitches will dissolve on their own. A dressing will cover the wound and can usually be removed after a week.
If your baby has a stoma, you will be shown how to care for it at home.
Management
Stoma
A stoma is an opening made in the abdomen to help remove poo or wee from the body, into a bag.
It may be needed if the bowel can’t be safely joined back together.
The surgeon will bring part of the bowel to the surface of the skin and stitch it in place.
Most stomas are temporary and can be closed once the bowel heals.
You will be supported in learning how to clean and care for the stoma.
When to seek help
Go to the emergency department straight away if your child:
- shows any of the symptoms listed above, after surgery
- shows signs of infection around the wound, including
- redness
- heat
- fever
- discharge or ooze.
If your baby vomits green liquid, this could mean a bowel blockage. Call triple zero (000) for an ambulance or go to the emergency department immediately.
