Paeds Vivas · gastroenterology-hepatology-and-nutrition
Malrotation and volvulus — branching viva
Branching viva on malrotation and volvulus: recognising bilious vomiting in a previously well neonate as a midgut volvulus until proven otherwise, choosing the upper gastrointestinal contrast study over a reassuring plain film, the whirlpool and corkscrew signs, resuscitation and when to bypass imaging for immediate laparotomy, describing the Ladd procedure, and then branching to the older child with intermittent volvulus and the incidental finding of asymptomatic malrotation.
On this page & tools
Target exams
Opening question
A three-day-old term neonate who fed and stooled normally has just vomited bright green bile. The baby is alert with a soft abdomen and the plain abdominal radiograph is reported as normal. What is the governing rule that drives this baby's management, what is the immediate plan, and why does neither the well-looking baby nor the normal film reassure you? [1] [2]
You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.
References4Show ledgerHide ledger
- [1]Godbole P; Stringer MD Bilious vomiting in the newborn: How often is it pathologic? J Pediatr Surg, 2002.PMID 12037761
- [2]Lampl B; Levin TL; Berdon WE; Cowles RA Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol, 2009.PMID 19241073
- [6]Ingoe R; Lange P The Ladd's procedure for correction of intestinal malrotation with volvulus in children. AORN J, 2007.PMID 17292689
- [5]Dekonenko C; Sujka JA; Weaver K; Sharp SW The identification and treatment of intestinal malrotation in older children. Pediatr Surg Int, 2019.PMID 30810798