Volvulus of the small bowel on common mesenterium in a 7-day-old boy

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Volvulus of the small bowel on common mesenterium in a 7-day-old boy

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Type de vidéo

Vidéo chirurgicale

Durée

04'44''

Publication

2006-09

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E-publication

WeBSurg.com, Sept 2006;6(09).
URL: http://www.websurg.com/doi-vd01en1996.htm

Volvulus of the small bowel on common mesenterium in a 7-day-old boy

1. Set-up 00'37''

The baby is placed in dorsal decubitus supine position. The surgeon stands at the patient’s feet. The monitor is placed at the patient’s head. The anaesthesiologist stands on the side. Three trocars are needed: one 5 mm optical trocar that is placed through the umbilicus and two 3 mm operating trocars that are placed lateral to the umbilicus and will be used for instruments.

2. Exploration 01'04''

As soon as the optic is introduced into the abdomen, chylous ascites is observed. This is secondary to a major lymphatic stasis as demonstrated by the presence of several lymphatic ectasias in the digestive tract. Exploration is performed into the antropyloric, and then duodenal region. The duodenum is tightly related to the right colon by means of a fibrous band, called a “Ladd\\\\\\\\'s band”.

3. Start of Procedure 01'40''

Freeing of the Ladd’s band is carried out using scissors. Very little use of monopolar cautery is required. Once the Ladd’s band has been divided, the loop of the small bowel is untwisted as shown here in a clockwise manner. The caecum is then reached as identified by the appendix. And the colon is placed entirely to the left of the abdominal cavity whereas the small bowel is untwisted to the right of the abdominal cavity. Freeing of the mesenterium is carried out and completed, hence allowing for correct positioning of the digestive tract in the abdomen.

4. End of procedure 04'31''

At the end of the procedure, appendicectomy is performed through the opening created by the left operating trocar. The caecum is then placed in the left iliac fossa. The postoperative course was uneventful. The patient was fed on the second postoperative day.