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.

Five Hundred Patients With Gut Malrotation

“…Patients with intact gut experienced digestive symptoms which were commonly incapacitating. With the first adult case being reported in 1960s, recent literature highlighted the common development of GM symptoms in both adults and children 37–41 . This study is the first to define the GMS comprising of pain, nausea/vomiting, and bloating.…”

“…This study is the first to document the cumulative incidence of midgut-loss with identification of several risk factors including volvulus, prematurity, gastroschisis, and intestinal atresia. Along with other scattered publications, Ladd's procedure and increasing age reduced but did not prevent the risk of volvulus 15–24,31–48 …”

“…Along with other scattered publications, Ladd's procedure and increasing age reduced but did not prevent the risk of volvulus. [15][16][17][18][19][20][21][22][23][24][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Patients with intact gut experienced digestive symptoms which were commonly incapacitating. With the first adult case being reported in 1960s, recent literature highlighted the common development of GM symptoms in both adults and children.…”

“…With the first adult case being reported in 1960s, recent literature highlighted the common development of GM symptoms in both adults and children. [37][38][39][40][41] This study is the first to define the GMS comprising of pain, nausea/vomiting, and bloating. The frequency and severity of these symptoms varied according to the distorted anatomy and altered motility of midgut with the development of intermittent volvulus.…”

“…The intent was to amend the anatomic deviation with limited stabilization of the mesentery 27–30 . More recently, a plethora of scientific publications has emerged, mainly as case series with a few review articles 31–51 . These reports attempted to better understand the disease spectrum and management strategies particularly among the adult population.…”