A painful condition associated with an abnormal position of the duodenum, caecum and midgut is called Ledd's syndrome. By what signs the presence of this pathology in the body is determined and what methods are guided in its treatment - we will deal with these issues in our article.
Ledd Syndrome
Anomaly of intestinal rotation, which is formed during fetal development (usually at 10-12 weeks) and is a compression of the duodenum by the caecum with volvulus of the midgut, has a certain name - Ledd's syndrome.
ICD-10 is the generally accepted classification for coding medical diagnoses developed by WHO. In accordance with this International Classification of Diseases of the 10th revision, Ledd's syndrome belongs to diseases of the digestive system (class XI). The pathological condition occurs no more than in one case in 500 newborns, and boys are diagnosed with a similar diagnosis twice as often as girls.
As a rule, the diagnosis is established in the first week of life of a small patient, a little less often- in the first month of life. To conduct a correct diagnosis, the pediatrician requires experience and a wide acquaintance with pathology. In this regard, the disease is not always detected in a timely manner. The most obvious sign of pathology in the first days of life is vomiting with an admixture of bile.
Unfortunately, the severity of the condition of a patient with a similar disease can be aggravated by concomitant congenital malformations, such as:
- hypoplasia of the kidneys or lungs;
- heart disease;
- pulmonary artery stenosis, etc.
Ledd syndrome in adults is extremely rare. Intestinal obstruction can be the result of mobility of the caecum, as well as adhesions in the abdominal cavity. Sometimes the formation of pathology is provoked by a hernia of the anterior abdominal wall. Not the last place among the factors influencing the formation of a disease state is played by benign and malignant tumors of various parts of the intestine.
Signs of disease
Ledd's syndrome in newborns may present with intermittent symptoms. In addition to vomiting and regurgitation of bile, babies have occasional abdominal pain. In some cases, relapses occur, leading to acute intestinal obstruction with deterioration, up to the collaptoid state of the child.
General symptoms of the syndrome:
- paroxysmal pain;
- stool retention, gas accumulation;
- vomit;
- bloating of the epigastric region;
- retraction of the lower abdomen;
- palpation does not give complete information about the patient's condition.
Abdominal x-ray reveals two levels of fluid in the stomach and duodenum, as well as a small amount of gas in the intestines. If barium sulfate was used during the procedure, the result indicates the accumulation of a contrast agent in the distended stomach and duodenum. At the same time, the contrast is evenly distributed along the loops of the small intestine.
Irrigography usually reveals fixation of the caecum under the liver. But with the help of computed tomography, a volvulus of the midgut around the mesenteric artery is determined.
Clinical picture
Ledda syndrome is a pathology that requires immediate surgical intervention. As noted earlier, the symptoms of the disease are inconsistent and can recur at intervals of several days, weeks, or even years.
In some cases, the disease state does not make itself felt for many years and is asymptomatic. At the same time, children suffer from reduced appetite and lag behind in physical development.
In addition to the classic Ledd's syndrome, there are additionally two of its forms:
- In the first case, there is no volvulus of the midgut, but an abnormal location of the caecum, which compresses the duodenum.
- In the second case, only isolated volvulus of the midgut occurs.
The course of pathology (Ledda's syndrome) can be acute and subacute (chronic). In the chronic form, there are not pronounced pains in thestomach, similar to intestinal colic, sometimes there is vomiting, malnutrition. There is broken stool. The child's condition is described as satisfactory. Volvulus of the intestine does not lead to disruption of its blood supply. In the veins of the small intestine, only stagnation of blood occurs and reactive changes are observed in the gastrointestinal tract.
Acute volvulus is a more serious condition that, if unfavorable, leads to necrosis or gangrene of the intestine.
Treatment of Ledd's syndrome
The use of antispasmodics helps to improve the general condition of the patient with a chronically relapsing course of the disease. However, this is only a temporary measure. The main method in the treatment of intestinal obstruction is still surgical intervention. Surgical treatment of pathology (Ledda syndrome) consists of several stages:
- First, torsion and obstruction are eliminated.
- Further, the small intestine is placed in the right side of the abdomen, the large intestine in the left.
- If there is a need to fix intestinal loops within the parietal peritoneum, perform this manipulation. A similar measure is required if the patient has abnormal intestinal motility.
- Appendectomy in progress.
Recently, laparoscopic methods of diagnosing and treating the syndrome have become widespread in medicine. Such mini-invasive technologies are highly effective. However, surgical intervention in this way is associated with some difficulties due to the small volume of the abdominal cavity, as well as smallthickness of the abdominal wall in children during the first months of life. Sometimes complications occur in the early postoperative period:
- sepsis;
- peritonitis;
- intestinal bleeding;
- intestinal obstruction.
The chances of a full recovery will depend on the results of the operation. If all parts of the gastrointestinal tract are preserved, the prognosis for a high level of quality of life is favorable. If significant intestinal resections have taken place, leading to the “short bowel” syndrome, the patient has problems associated with food intake and malnutrition. With such results of surgical treatment, multiple hospitalizations are carried out for the purpose of parenteral nutrition. Occasionally, patients will have to undergo repeated surgeries. If intestinal obstruction has developed against the background of cystic fibrosis, the prognosis for recovery is poor.
Preoperative preparation
As soon as a newborn is diagnosed with intestinal obstruction (Ledda syndrome), he is transferred to a surgical hospital, a nasogastric tube is inserted and a constant outflow of stomach contents is ensured. The time required to carry out preparatory preoperative measures directly depends on the severity of congenital intestinal obstruction.
If a volvulus is suspected in a small patient, the following diagnostic measures are performed:
- blood test for group and Rh factor;
- blood test for hemoglobin and hematocrit levels;
- blood clotting test.
Surgical treatment is performed on an emergency basis, preoperative preparation takes a maximum of one hour. The child is given infusion therapy, hemostatics, painkillers, and sometimes artificial lung ventilation are prescribed. A catheter is inserted into the central vein.
In case of low intestinal obstruction, preoperative preparation can take up to 24 hours. During this time, the newborn is additionally examined in order to possibly identify comorbidities. At the same time, drainage of the stomach is performed, the volumes of the removed masses are taken into account, infusion therapy, antibiotics and hemostatic drugs are prescribed. Feeding the newborn is excluded.
Most children in the postoperative period undergo prolonged mechanical ventilation, which can last up to five days. Antibacterial therapy uses drugs that are active against anaerobic bacteria. The microecological status is monitored at least twice a week. A day after the operation, drugs are prescribed to improve intestinal motility, as well as biological products.
