dr. Lisa

1st described Calder (1733) 1st successful repair Ernst (1914) Prematurity, growth retardation, coexistent

malformations 50% cardiac, genitourinary, anorectal,

esophageal atresia 30-40% trisomy 21 Down syndrome abn pancreatic tissue, biliary atresia,

agenesis of the gallbladder, stenosis of the CBD

Failure of recanalization partial / complete

Intrinsic webs (perforate/imperforate), atresia, & stenoses

rotation failure of ancreatic ventral anlage annular pancreas

Stenosis, or incomplete obstruction diaphragm/web + small opening

thin web + ballooned distally windsock

Atresia / complete obstruction duodenal muscular continuity or pancreatic tissue filled in gap

Type I, II, III

Plain abdominal x-rays classic “double-bubble” sign dilated stomach & duodenal bulb w/ intraluminal air & fluid, no distal air pattern

Intestinal gas beyond duodenum incomplete obstruction

Contrast meal malrotation & volvulus Air filled biliary tree rare pancreatic &

biliary anomalies Contrast enema inexact for malrotation

Antenatal dilated stomach, duodenum & polyhydramnios (fetal USG 18 weeks)

Perinatal bilious emesis / high gastric aspirates, scaphoid abdomen

Plain abdominal x-rays classic “double-bubble” sign

Gas in the distal segment stenosis, perforate web, Ladd bands

Delayed diagnosis dehydration, hyponatremia, & hypochloremia

Malrotation & Midgut Volvulus

Gastric decompression (NGT) + correction of fluid & electrolyte

USG of the head & urinary tract other anomalies

Echocardiography cardiac malformation Genetic consultation for chromosomal

analysis trisomy / Down syndr? After resuscitation operative correction Urgent surgery if malrotation & volvulus ?

Warming overhead warming lights, warming blanket, 24oC operating room

Transverse supraumbilical incision Inspected for fixated right colon &

rotated ligament of Treitz Malrotation (-) extensive Kocher

(lysis to the mesenteric root) duodenal obstruction + pancreas

Kimura technique a widely patent “diamond-shaped” anastomosis

excessively dilated duodenum weak motility + significantly slower peristaltic frequency stasis & bacterial overgrowth

LaPlace’s Law function & long-term poor emptying improved by reducing diameter

longitudinal axis of antimesenteric wall resection w/ appropriate caliber of catheter in the lumen GI stapler

Op + ICU + parenteral nutrition survival 95%

TERIMA KASIH