Sustaining viability in a pre-gangrenous bowel with midgut volvulus

Authors

  • Fatima Al Zahra Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
  • Nadeem Akhtar Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
  • Sana Khan Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
  • Mohammed Abdulmomen Abdullah Saif Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
  • Muhammad Umair Butt Department of Pediatric Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
  • Ramsha Syed Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

DOI:

https://doi.org/10.18203/2349-3291.ijcp20212493

Keywords:

Volvulus, Ischemia, Obstruction

Abstract

Midgut volvulus is a condition peculiar to neonates having acute abdomen. The condition is anticipated in any neonate having bilious vomitus and inability to pass stools. This being a surgical emergency does not sanction any time-consuming radiological procedures, thus, history and the clinical picture are sufficient to warrant surgical exploration. A sick neonate in the 2nd week of life presented with all signs and symptoms of midgut volvulus for which he was explored. Exploration gave the outlook of a necrotic midgut along its entire length. No haste was made in resection as it had a fatal prognosis for survival, instead, watchful waiting opted after necessary measures were taken to allow for the resumption of perfusion. Not only the baby survived to undergo a relook laparotomy showing marked improvement but also showed improvement in lab values and started passing stool and tolerating orally after a wait of three weeks post 1st laparotomy. Midgut volvulus leading to seemingly necrotic intestine should be given due consideration by relook surgery. The alternative would be total resection followed by short bowel syndrome, need for an intestinal transplant while being on TPN. This approach gives an immense advantage by giving the gut a fair chance to restore its perfusion by gut rest after de-twisting.  

Author Biographies

Fatima Al Zahra, Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

Pediatric Surgery

Nadeem Akhtar, Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

Pediatric Surgery

Sana Khan, Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

Pediatric Surgery

Mohammed Abdulmomen Abdullah Saif, Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

Pediatric Surgery

Muhammad Umair Butt, Department of Pediatric Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

Pediatric Surgery

Ramsha Syed, Department of Pediatric Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan

Pediatric Surgery

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Published

2021-06-24

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Section

Case Reports