Keywords
Ladd procedure
Duodenal obstruction
Gastrojejunostomy
Case report
Adult
Categories
How to Cite
Abstract
Intestinal malrotation is a congenital anomaly commonly occurring in infancy, with adult presentation being rare. The Ladd procedure is the standard treatment for symptomatic malrotation; however, postoperative complications in adults, including obstruction of the second portion of the duodenum (D2), remain poorly characterized, and their etiology may be multifactorial.
A 28-year-old male with chronic gastrointestinal symptoms underwent an elective robotic-assisted laparoscopic Ladd procedure for intestinal malrotation discovered on imaging. He developed persistent high-volume bilious gastric output from postoperative day five; CT and upper GI contrast study failed to identify a transition point. Due to persistent symptoms and radiographic–clinical discordance, esophagogastroduodenoscopy was performed and revealed high-grade narrowing of the second portion of the duodenum. Reoperation revealed dense retroperitoneal fixation precluding safe duodenal mobilization; gastrojejunostomy was performed. Postoperative recovery was complicated by transient dumping syndrome, which improved with dietary modification.
D2 obstruction identified early after the Ladd procedure is rare in adults but should be considered when persistent high-output gastric decompression follows surgery. Whether this obstruction was newly created by surgery or represented a pre-existing congenital abnormality unmasked postoperatively could not be determined, as no baseline assessment of duodenal patency was performed. This case illustrates the potential value of endoscopic evaluation when standard imaging and clinical findings are discordant. Follow-up was limited to two weeks, and longer-term outcome data are needed.
References
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Copyright (c) 2026 Akram Alnounou, DO, Ajay Katwala, Bisher Sawaf, MD, MSc, Arghyadeep Ganguly, MD, Yusuf Hallak, MD