Laparoscopic Ladd’s Procedure for Duodenal Occlusion in an Adult: A Case Report and Review of Literature

Abstract

Introduction: Malrotation of the gut is a congenital anomaly that typically presents in childhood. Its occurrence in adults is extremely rare, with an incidence of approximately 0.2%. Ladd’s bands, which can cause duodenal obstruction, may present with symptoms such as abdominal pain, nausea, and vomiting. In adults, the condition often manifests with more chronic and nonspecific symptoms, including recurrent abdominal discomfort, bloating, and constipation, and may occasionally present acutely with intestinal obstruction or midgut volvulus. Aim: This study aimed to report a case of an adult patient with duodenal occlusion, treated with Laparoscopic Ladd’s Procedure. Moreover, the study reported similar and existing studies to emphasise the significance of the laparoscopic approach. Case Presentation: The case of a 35-year-old male presenting with duodenal occlusion secondary to Ladd’s bands was reported. The patient underwent exploratory laparotomy through a midline incision. After fifteen years, the patient presented again with complications. Upon laparoscopic inspection, previous laparotomy scars were noted. The patient was treated using the Ladd’s procedure. Oral feeding was initiated on the second postoperative day, and the patient recovered uneventfully. He was discharged on the fifth postoperative day after full recovery. Discussion: Ladd’s bands are fibrous peritoneal structures that connect the cecum to the retroperitoneum. They pass over the second part of the duodenum, leading to extrinsic compression and obstruction. The most severe complication of malrotation is midgut volvulus, where the mesenteric base twists around the superior mesenteric artery, potentially resulting in intestinal ischemia, perforation, and bowel necrosis. In children, malrotation typically presents acutely within the first month or year of life. In adults, the presentation is more variable and may even be asymptomatic. Diagnosis in adults is often challenging. Conclusion: The laparoscopic Ladd’s procedure is a safe and effective surgical approach. However, in emergencies, such as cases involving midgut volvulus with intestinal necrosis, an open laparotomy should be preferred.