VOLVULUS SUR MéSENTÈRE COMMUN : PIÈGES DIAGNOSTIQUES

Abstract

Small bowel volvulus represents one of the major complications of midgut congenital malrotation. It can show itself during antenatal period, perinatal period (50 to 75% before age one month) or in grown-up children. Considering the risk of intestinal necrosis the diagnosis should be called to mind in front of any neonatal intestinal obstruction. this stady is to show the purpose diagnostic of difficulties in our ordinary clinical practice. Records of children who had an operation for intestinal obstruction due to malrotation in the department of pediatric surgery of Albert Royer’s hospital were identified from January 2009 to June 2011. The exclusion criteria were the association of predisposing factors (omphalocele, gastroschisis, diaphragmatic hernia). Nine children were included in the study. Two 17- days - old newborn presented bilious vomiting from day 2 and day 4 of birth, Seven nursling (ages: 2; 4; 6; 7; 8; 16 and 29 months) presented, from the first days of birth, intermittent bilious vomiting which justified several consultations and admissions in pediatrics. The upper gastrointestinal radiological investigations established duodenal or jejunal obstruction (7 cases) and the diagnosis of intestinal malrotation confirmed by ultrasonography (2 cases).All the patients underwent a Ladd procedure for small bowel volvulus due to midgut malrotation. The post-operative follow-up was good in 7 cases. A patient died of Mendelson syndrome and a second one of infection. The gravity of this anomaly needs surgical treatment after performing early diagnosis based on Doppler ultrasound and the upper gastrointestinal radiological investigations. Follow-up care to prevent recurrence is also necessary. Key words : Sm