A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

Abstract

Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd's band was diagnosed based on clinical acumen, high- resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd's procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd's band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.

Keywords: exploratory laparotomy; failure to thrive; intestinal malrotation..

Figure 1.. Barium follow through shows left sided large bowel loops.

Figure 2.. CECT shows predominantly left sided large bowel loops with whirlpool sign and inverted SMA/SMV relation.

Figure 3.. Hugely dilated proximal jejunum with malroated mesentery and distal jejunum and ileum with floating caecum.

Figure 4.. After derotation of gut and decompression of proximal gut, showing superior mesenteric vessels.