14-year-old boy with twisted intestines gets new lease of life at Sarvodaya Hospital

Faridabad: A 14-year-old boy with twisted intestines, who was experiencing greenish vomit and excruciating pain for the last few days due to a blockage in the abdomen, underwent emergency surgery at Sarvodaya Hospital, Sector-19, Faridabad, saving his life in the nick of time. 

The condition, known as malrotation, is rarely found in grown-up children. It is a congenital anomaly which results from failure of the GI tract to undergo the usual counter-clockwise rotation during embryologic development.

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Malrotation may lead to twisting of the intestines (midgut volvulus), causing blockage of blood supply to the gut, risk of gangrene and complete loss of the small intestine. Death is inevitable if not treated immediately.

Lakshay Sharma, the patient, could never take a full meal in his life, restricting his food intake to not more than two chapatis. This is a clinical clue of malrotation. He was brought to Sarvodaya Hospital, Sector-19, Faridabad, with agonizing pain in the abdomen and not responding to any medication.

Said Dr. Anand Gupta, Senior Consultant – Paediatrics, Sarvodaya Hospital, Sector 19, Faridabad: "The child presented himself with fever at the hospital and was diagnosed with typhoid. He had intense abdominal pain, so we suspected malrotation as one of the possibilities. This is a medical condition where the intestines twist upon themselves, leading to blockage. It is a very rare occurrence in this age group. The condition needs emergency surgery once diagnosed. Any delay may cause death or loss of the intestine, thereby leading to short bowl syndrome."

Said Dr. Shweta Kumari Sharma, Consultant - Pediatric Surgery, Sarvodaya Hospital, Sector-19, Faridabad: "The patient was found to have acute intestinal obstruction due to malrotation and midgut volvulus. The child had gone into shock due to falling blood pressure and was having seizure. He was immediately given artificial resuscitation and rushed to surgery. When his abdomen was opened, the intestines were found to be totally black and swollen due to lack of blood supply."

The doctor added: "Malrotation with midgut volvulus is a surgeon's nightmare. The three-hour surgery, called Ladd procedure, involved repositioning the intestine to correct the anomaly. The patient's intestine was straightened out, the Ladd's bands were divided, the small intestine was folded into the right side of the abdomen, and the colon was placed on the left side. Resuming blood supply of the whole intestine through derotation saved the child's life. Quick diagnosis and immediate surgery proved to be game changers."

Dr. Shweta Kumari Sharma said: "The postoperative course for the child was difficult due to presence of toxins in the blood (toxemia), but he showed steady progress and recovered well. We started feeding him five days after the surgery. He needs to take only liquid and soft diet for a couple of weeks, as it takes time for the intestine to restore the digestive and enzymatic activity. There will be slow and gradual return to a normal diet, as per clinical progress of the patient. The child is now expected to be as good and healthy as any normal individual."

It is rare to find cases of malrotation and midgut volvulus in teenagers, according to Dr. Anand Gupta. "It is a congenital developmental anomaly. While asymptomatic malrotation is present in 1 in 500 live births, symptomatic malrotation with midgut volvulus occurs in 1 in 6,000 live births. Once detected, surgical correction is carried out immediately to prevent intestinal twisting and blockage from occurring, which can have devastating consequences. About 80% of cases of malrotation are detected within the first month of life, so it was surprising to see such a case in a 14-year-old boy," he added.

Said the boy Lakshay Sharma: "I always faced a lot of discomfort in eating a full meal, but none of us had any idea that I may be suffering from such a serious medical condition. Things worsened in the last few days, and the pain in my stomach was unbearable. When I collapsed, my parents rushed me to the hospital. This is like a new lease of life for me. I thank the doctors of Sarvodaya Hospital, Faridabad, for saving my life by moving quickly and performing this very difficult surgery. I am glad I will be able to live like any other normal person now and look forward to eating a full meal for the first time in my life."

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