Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Jul 31;58(228):600-603.
doi: 10.31729/jnma.5134.

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

Anita Lamichhane  1 , Rupesh Sharma  2 , Ramana Rajkarnikar  3 , Rubee Awale  1 , Prapti Shrestha  1 , Nava Chandra Oli  1
Affiliations
Case Reports

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

Anita Lamichhane et al. JNMA J Nepal Med Assoc. .

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..

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.. Barium follow through shows left sided large bowel loops.
Figure 2.
Figure 2.. CECT shows predominantly left sided large bowel loops with whirlpool sign and inverted SMA/SMV relation.
Figure 3.
Figure 3.. Hugely dilated proximal jejunum with malroated mesentery and distal jejunum and ileum with floating caecum.
Figure 4.
Figure 4.. After derotation of gut and decompression of proximal gut, showing superior mesenteric vessels.
See this image and copyright information in PMC

References

    1. Balraj TA, Srinivas S, Reddy KR, Reddy GM, Inugala A. Malrotation presenting beyond infancy: a clinical study. Int Surg J. 2018;5(10):3288–91. doi: 10.18203/2349-2902.isj20184076. - DOI
    1. Nagdeve NG, Qureshi AM, Bhingare PD, Shinde SK. Malrotation beyond infancy. J Ped Surg. 2012;47:2026–32. doi: 10.1016/j.jpedsurg.2012.06.013. - DOI - PubMed
    1. Grassi C, Conti L, Palmieri G, Banchini F, Dacco MD, Cattaneo GM, et al. Ladd’s band in the adult, an unusual case of occlusion: Case report and review of the literature [published online ahead of print, 2020 May 11] Int J Surg Case Rep. 2020;71:45–49. doi: 10.1016/j.ijscr.2020.04.046. - DOI - PMC - PubMed
    1. Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17:326–331. doi: 10.1007/BF01658699. - DOI - PubMed
    1. Durkin ET, Lund DP, Shaaban AF, Schurr MJ, Weber SM. Age-related differences in diagnosis and morbidity of intestinal malrotation. J Am Coll Surg. 2008;206(4):658–663. doi: 10.1016/j.jamcollsurg.2007.11.020. - DOI - PubMed

Publication types

LinkOut - more resources