Complications
For survivors of midgut volvulus with ischaemic necrosis, the risk of short gut syndrome is related to the amount of bowel lost.
When a large amount of small intestine must be resected to allow for survival due to a long segment of necrotic bowel, the survivors are likely to have inadequate bowel length. This will cause inability to sustain life and growth with enteric intake and require long-term parenteral nutrition.
These patients need multi-disciplinary care ideally in an institution with a dedicated team experienced with this population.
Short bowel syndrome patients may require consideration for small bowel transplant on a case-by-case basis. It is fear of this complication that should drive a second-look operation rather than early commitment to long segment resections, unless the bowel is frankly necrotic and must be resected to establish clinical stability.
Any patient with malrotation maintains a risk of volvulus.
Rotational correction cannot be completed surgically. The retro-peritoneal attachments cannot be recreated. A pre-existing narrow base of mesentery cannot be made normal with an operation, but it can be broadened to its fullest extent.
The Ladd's procedure is intended to decrease the risk of future volvulus and decrease the complications of malrotation, such as the atypical presentation of appendicitis. However, the underlying anatomy continues to predispose to future volvulus.
The operation does allow the surgeon to have a better feel for the risk of future volvulus based on the anatomy found during the operation. Regardless of prior surgery, any patient with known malrotation who presents with bilious vomiting must have volvulus immediately ruled out.
Any patient with a history of an abdominal operation maintains a risk of adhesive bowel obstruction.
An abdominal operation may induce adhesions, which can tether the small bowel to the abdominal wall or to other internal structures. These adhesions create spaces for internal hernias and tether points around which the bowel can twist or be pinched in an obstructive way.
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