A painful condition associated with abnormalthe position of the duodenum, blind and midgut, is called Ledd's syndrome. On what grounds determine the presence in the body of this pathology and what methods are guided in its treatment - we will deal with these issues in our article.
The bowel rotation anomaly that formsduring fetal development (usually at 10-12th week) and represents compression of the duodenum with the caecum with a turn in the middle gut, has a specific name - Ledd's syndrome.
ICD-10 is a generally accepted coding classificationmedical diagnoses, developed by WHO. In accordance with this International Classification of Diseases of the 10th revision, Ledd's syndrome refers to diseases of the digestive system (class XI). The pathological condition is found no more often than in one case for 500 newborns, and boys are twice as likely to be diagnosed as to girls.
Unfortunately, the severity of the condition of a patient with a similar disease can be exacerbated by concomitant congenital malformations, such as:
Ladd's syndrome in adults is extremely rare.Intestinal obstruction can result from the mobility of the cecum, as well as the adhesive process 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 formation of a morbid state, benign and malignant tumors of various departments of an intestine play.
Синдром Ледда у новорожденных может проявляться unstable symptoms. In addition to vomiting and regurgitation of bile, infants occasionally experience abdominal pain. In some cases, relapses occur leading to acute intestinal obstruction with worsening, up to the collapoid state of the child.
General symptomatology of the syndrome:
Рентгенография брюшной полости выявляет два the level of fluid in the stomach and duodenum, as well as a small amount of gas in the intestine. If barium sulfate was used during the procedure, the result indicates the accumulation of contrast medium in the stretched stomach and duodenum. The contrast is evenly distributed over the loops of the small intestine.
Irrigography usually reveals the fixation of the cecum under the liver. But with the help of computed tomography, the mid-gum turns around the mesenteric artery.
Ledda syndrome is a pathology that requiresimmediate surgical intervention. As noted earlier, the symptoms of the disease are variable and can be repeated at intervals of several days, weeks, or even years.
In some cases, the painful condition does not make itself felt for many years and is asymptomatic. Children suffer from reduced appetite, and are lagging in physical development.
In addition to the classic Ledda syndrome, there are additionally two of its forms:
The course of pathology (Ledda syndrome) can beacute and subacute (chronic). In the chronic form, there are not sharply expressed abdominal pains, like intestinal colic, sometimes vomiting, hypotrophy. There is a broken chair. The condition of the child is characterized as satisfactory. Inversion of the intestine does not lead to disruption of its blood supply. In the veins of the small intestine, only a stagnation of blood occurs and reactive changes are observed in the gastrointestinal tract.
Acute inversion of the intestine is a more serious condition, which in an unfavorable course leads to necrosis or gangrene of the intestine.
To improve the general condition of the patient withthe use of antispasmodic agents helps with the 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:
Recently, in medicine have gained widethe spread of laparoscopic methods of diagnosis and treatment of the syndrome. Such mini-invasive technologies are highly efficient. However, performing a surgical procedure in this way is associated with some difficulties, due to the small volume of the abdominal cavity, as well as the small thickness of the abdominal wall in children during the first months of life. Sometimes in the early postoperative period there are complications:
The chances of a full recovery will depend onthe results of the operation. If all sections of the gastrointestinal tract are preserved, the prognosis for a high level of quality of life is favorable. If there were significant intestinal resections that led to the “short bowel” syndrome, the patient has problems with food intake and hypotrophy. With such results of surgical treatment, repeated hospitalizations are carried out for the purpose of parenteral nutrition. Sometimes patients are waiting for repeated operations. If intestinal obstruction has developed against the background of cystic fibrosis, the prognosis for recovery is unfavorable.
As soon as a newborn is diagnosedintestinal obstruction (Ledda syndrome), it is transferred to a surgical hospital, a nasogastric tube is inserted and the stomach contents are continuously drained. The time required for the preparation of preoperative measures depends on the severity of congenital intestinal obstruction.
If a small patient suspects inversion of the intestine, the following diagnostic measures are performed:
In case of low intestinal obstructionpreoperative preparation can take up to 24 hours. During this time, the newborn is additionally examined for the purpose of possible detection of comorbidities. At the same time, gastric drainage is performed, the volumes of abstracted masses are taken into account, infusion therapy, antibiotics and hemostatic preparations are prescribed. Feeding a newborn is excluded.
Most children in the postoperative periodconduct prolonged artificial ventilation of the lungs, which can last up to five days. Antibacterial therapy uses drugs that are active against anaerobic bacteria. Micro-ecological status is controlled at least twice a week. One day after surgery, drugs are prescribed to improve intestinal motility, as well as biologics.
