A painful condition associated with the abnormal position of the duodenum, blind and middle intestine is called Ledda's syndrome. By what signs they determine the presence of this pathology in the body and by what methods are guided in its treatment - we will deal with these issues in our article.
Ledda's Syndrome
An anomaly of bowel rotation, which forms during prenatal development (usually at the 10-12th week) and is a compression of the duodenum by the cecum with inversion of the middle intestine, has a specific name - Ledda's syndrome.
ICD-10 is a generally accepted classification of coding for medical diagnoses developed by WHO. In accordance with this International Classification of Diseases of the 10th Revision, Ledd's Syndrome belongs to diseases of the digestive system (class XI). The pathological condition occurs not more often than in one case for 500 newborns, and boys are diagnosed with this diagnosis twice as often as girls.
As a rule, the diagnosis is made in the first week of life of a small patient, a little less often - in the first month of life. In order to conduct a correct diagnosis, the pediatrician requires experience and a wide acquaintance with the pathology. In this regard, the disease is not always detected in a timely manner. The most obvious sign of pathology in the first days of life is vomiting with an admixture of bile.
Unfortunately, the severity of the condition of a patient with a similar disease can be aggravated by congenital malformations, such as:
- hypoplasia of the kidneys or lungs;
- heart disease;
- pulmonary stenosis, etc.
Ledda's syndrome in adults is extremely rare. Intestinal obstruction can result from mobility of the cecum, as well as adhesions in the abdominal cavity. Sometimes the formation of pathology is provoked by a hernia of the anterior abdominal wall. Not the last place among the factors influencing the formation of a disease state is played by benign and malignant tumors of various parts of the intestine.
Signs of the disease
Ledda's syndrome in newborns can manifest with intermittent symptoms. In addition to vomiting and regurgitation of bile, babies periodically experience abdominal pain. In some cases, relapses occur, leading to acute intestinal obstruction with deterioration, up to the collaptoid state of the child.
General symptoms of the syndrome:
- paroxysmal pain;
- stool retention, gas congestion;
- vomiting
- bloating of the epigastric region;
- retraction of the lower abdomen;
- palpation does not provide complete information about the patient's condition.
An abdominal x-ray reveals two levels of fluid in the stomach and duodenum, as well as a small amount of gas in the intestine. If barium sulfate was used during the procedure, the result indicates the accumulation of contrast medium in the distended stomach and duodenum. The contrast is evenly distributed over the loops of the small intestine.
Irrigography usually reveals fixation of the cecum under the liver. But with the help of computed tomography, the inversion of the middle intestine around the mesenteric artery is determined.
Clinical picture
Ledda syndrome is a pathology that requires immediate surgical intervention. As noted earlier, the symptoms of the disease are unstable and can be repeated with a frequency of several days, weeks, or even years.
In some cases, the painful condition does not make itself felt for many years and is asymptomatic. At the same time, children suffer from reduced appetite and lag behind in physical development.
In addition to the classic Ledd's syndrome, two additional forms are distinguished:
- In the first case, there is no inversion of the middle intestine, but an abnormal arrangement of the cecum is observed, which compresses the duodenum.
- In the second case, there is only an isolated inversion of the middle intestine.
The course of the pathology (Ledda syndrome) can be acute and subacute (chronic). In the chronic form, there are not pronounced abdominal pains, similar to intestinal colic, sometimes vomiting, hypotrophy appears. There is a broken chair. The condition of the child is characterized as satisfactory. Inversion of the intestine does not lead to a violation of its blood supply. In the veins of the small intestine, only blood stagnation occurs and reactive changes are observed in the gastrointestinal tract.
Acute inversion of the intestine is a more serious condition, which in an adverse course leads to necrosis or gangrene of the intestine.
Ledd's Syndrome Treatment
The use of antispasmodic drugs helps to improve the general condition of the patient with a chronically relapsing course of the disease. However, this is only a temporary measure. The main method in the treatment of intestinal obstruction is nevertheless surgical intervention. Surgical treatment of pathology (Ledda syndrome) consists of several stages:
- First, inversion and obstruction are eliminated.
- Next, the small intestine is located in the right abdomen, the colon in the left.
- If there is a need to fix the intestinal loops within the parietal peritoneum, this manipulation is performed. A similar measure is required if the patient has abnormal intestinal motility.
- Appendectomy is performed.
Recently, laparoscopic methods for diagnosing and treating the syndrome have become widespread in medicine. Similar minimally invasive technologies are highly effective. However, surgical intervention in this way is associated with some difficulties due to the small volume of the abdominal cavity, as well as the small thickness of the abdominal wall in children of the first months of life. Sometimes in the early postoperative period complications arise:
- sepsis;
- peritonitis;
- intestinal bleeding;
- intestinal obstruction.
The chances of a full recovery will depend on the results of the operation. If all sections of the gastrointestinal tract are preserved, the prognosis for a high level of quality of life is favorable. If there were significant intestinal resections that led to the syndrome of the "short intestine", the patient has problems associated with food intake and malnutrition. With these results of surgical treatment, multiple hospitalizations are carried out in order to conduct parenteral nutrition. Sometimes patients will have repeated operations. If intestinal obstruction develops amid cystic fibrosis, the prognosis for recovery is poor.
Preoperative preparation
As soon as the newborn is diagnosed with intestinal obstruction (Ledda syndrome), he is transferred to a surgical hospital, a nasogastric tube is inserted and a constant outflow of stomach contents is provided. The time required for preparatory preoperative measures depends on the severity of congenital intestinal obstruction.
If a small patient is suspected of intestinal torsion, the following diagnostic measures are performed:
- blood test per group and Rh factor;
- blood test for hemoglobin and hematocrit;
- blood coagulation test.
Surgical treatment is performed on an emergency basis, preoperative preparation takes a maximum of one hour. The child is given infusion therapy, hemostats, painkillers, and sometimes mechanical ventilation are prescribed. A catheter is inserted into the central vein.
In the case of low intestinal obstruction, preoperative preparation can take up to 24 hours. During this time, the newborn is additionally examined for the possible identification of concomitant pathologies. At the same time, drainage of the stomach is performed, the volumes of the removed masses are taken into account, infusion therapy, antibiotics and hemostatic drugs are prescribed. Feeding a newborn is excluded.
In the postoperative period, most children undergo prolonged mechanical ventilation, which can last up to five days. Antibacterial therapy uses drugs that are active against anaerobic bacteria. Microecological status is monitored at least twice a week. A day after the operation, drugs are prescribed to improve intestinal motility, as well as biological products.