I have operated on a 10 day old newborn who came with bilious vomiting for one day. No feeding problems since birth. Upper GI confirmed presence of malrotation. O/E slightly distended abdomen with some tenderness. Good bowel sounds.
OR findings: Malrotation of the midgut with volvulus. Ischemic but viable bowel. Ladd's procedure performed( de-rotation counterclockwise, lysis of Ladd's bends, appendectomy, positioning of SB on right side and large bowel on left side). Proximal bowel: 15 cm of proximal jejunum had borderline viability and no significant improvement in color following de-rotation. This segment was partially devascularized during lysis of Ladd's bands. No resection done. ( I would have resected in adult this kind of bowel). Next day in am baby was looking very well, extubated and bowel signs present. At the end of the day baby got more distended and developed mild metabolic acidosis (PH 7.29, bicabs 18). 2nd look laparotomy done - bowel looked well and viable.
Pediatric bowel more resistant to ischemia and devascularization. Give more credit to joung bowel.
Any comments? Pediatric experience?