Ladd’s Band Obstruction in 61 Year Old Physician

Abstract

Ladd’s Band obstruction and congenital malrotation of the intestines is a rather uncommon anomaly with an incidence of 1 in 500 births and with symptomatic cases only appearing in 1 out of every 6000 births [1], [2]. Malrotation occurs when any part of the normal developmental cycle arrests and prevents the total 270 degrees of counterclockwise rotation. This will orient the caecum, appendix, and colon to the left side of the abdomen and the small bowel to the right. The ligament of treitzis also absent. When malrotation occurs, physiological absorption of primitive mesentery may not hapen1. This forms peritoneal bands that may obstruct the small bowel. These bands are known as Ladd’s bands and were described in 1932 by William Ladd in multiple cases of small bowel obstruction in children. Treatment of acute bowel obstruction secondary to peritoneal bands typically involves surgery to lyse the obstructing band. This procedure is known as the Ladd’s procedure and is usually accompanied with returning the intraabdominal organs to their anatomical position and an appendectomy to avoid future sequela1. This procedure is an open procedure, but can be done laparoscopically Most (40%) affected patients present within the first week of life with the large majority (75–85%) then presenting within the first year [3]. Incidence rates in adults become increasingly small and one estimate shows an occurrence of 0.16% within the adult population [4]. I present a case of a 61 year old man with undiagnosed malrotation who presented with acute small bowel obstruction. This would be one of the oldest patients presenting with a small bowel obstruction from Ladd’s band adhesions.