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Malrotation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Simon Blackburn, Joseph I. Curry, Bhanumathi Lakshminarayanan
Once access to the abdomen is established, the diagnosis is confirmed by identifying the position of the duodenojejunal flexure and the ileocecal junction. The volvulus is reduced. The right colon is then reflected to the patient’s left to expose the duodenum. At this point, careful division of the attachments between the duodenum and colon proceeds to reveal the superior mesenteric artery. The duodenum is then straightened by division of its right lateral attachments. The small bowel can then be brought to the right of the abdomen by gentle manipulation into the right upper quadrant, progressing from the duodenal end to the ileocecal junction. Peritoneal attachments restricting this are divided as they are encountered. This rewards the operator with a view of the small bowel mesentery with the small bowel on the right of the image and the colon to the left. Final division of the attachments between the small bowel and colon establishes a non-rotated position. Appendectomy can then proceed if desired.
Management of Enterocutaneous Fistula
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Jonathan C. Epstein, Mattias Soop
In these situations the surgical formation of a proximal loop jejunostomy may result in a more manageable situation. The area of the left upper quadrant in the region of the duodenojejunal flexure is often relatively accessible even in the hostile abdomen, allowing safe exteriorisation of a loop of proximal bowel.3 The creation of this very high-output stoma is at least manageable and usually preferable to an uncontrolled fistula within an excoriated wound. This can usually be done through a trephine incision in the left upper quadrant, as a full laparotomy is often technically not possible in this situation. The wound may need to be extended to allow some mobilisation to free up a loop of small bowel.
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The finding of a smooth nodular protrusion into the duodenum with a central depressed duct remnant is diagnostic for ectopic pancreatic tissue. Benign lymphoid hyperplasia typically demonstrates multiple filling defects and can be a normal variant in children but is indicative of hypogammaglobulinaemia in adults. Duodenal ulcers are most commonly more proximally in the bulbar part of the duodenum and are also more commonly anteriorly rather than posteriorly positioned. An adenocarcinoma of the papilla of Vater would be positioned laterally, expected to have ill-defined edges and may lead to obstruction. The duodenojejunal flexure is normally positioned in this patient and so malrotation would not be a concern.
Coronary Sinus Defect, Premature Restriction of Foramen Ovale and Cysto-Colic Peritoneal Band
Published in Fetal and Pediatric Pathology, 2023
Gastrointestinal tract and mesenteric development are embryologically complex and provides a platform for the formation of a wide variety of peritoneal bands. These bands are most commonly identified in the regions of the duodenum, duodenojejunal flexure, ileocecal junction, and ascending colon. The diverse location of these variant structures result in variable clinical manifestations. These may range from bloating, constipation, nausea, vomiting, abdominal distention, intermittent to chronic vague abdominal pain, and localized abdominal tenderness. The bands may also cause relatively severe complications including intermittent colicky pain, malabsorption, intestinal malrotation with or without midgut volvulus, internal herniation, intestinal stasis and/or obstruction, necrosis, and organ atrophy [4]. A Cysto-colic band, specifically, may either remain asymptomatic, manifest the aforementioned milder symptoms, or cause gallbladder atrophy, large intestinal stasis, obstruction and necrosis.