title: Assessment of recurrent abdominal symptoms after Ladd procedure: clinical and radiographic correlation.
abstract: OBJECTIVE
  Obstructive symptoms in a patient post-Ladd procedure raise the question of recurrent volvulus. Our objective is to determine the incidence and the radiographical evaluation of recurrent volvulus and abdominal complications after a Ladd procedure.
  
  
  METHODS
  One hundred ninety-five patients who underwent a Ladd procedure for malrotation for 10 years were retrieved from a database. Forty-eight patients were excluded (false-positive studies, heterotaxy, diaphragmatic hernia, abdominal wall defects). Of the remaining 147, 38 patients presented with abdominal symptoms. Surgical records and imaging were reviewed.
  
  
  RESULTS
  Of 38 patients, 33 had imaging studies including abdominal radiographs (AXR) and/or upper gastrointestinal examinations. Of these 33 patients, 17 had normal or expected imaging findings on AXR and/or upper gastrointestinal. Of the 11 patients who had surgery, 8 had an AXR. Of these, only a single patient had a normal AXR. The most common post-Ladd complication found at reoperation was small bowel obstruction secondary to adhesions (5.4%). One patient (0.7%) had midgut volvulus.
  
  
  CONCLUSIONS
  Although recurrent volvulus is a feared postoperative Ladd complication, it rarely occurs. Adhesive small bowel obstruction is more common, and an AXR with clinical findings is sufficient for diagnosis.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, Phildelphia, PA 19104, USA. david.biko@med.navy.mil
authors.forename: David M
authors.initials: DM
authors.lastname: Biko
authors.forename: Sudha A
authors.initials: SA
authors.lastname: Anupindi
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Hanhan
authors.forename: Thane
authors.initials: T
authors.lastname: Blinman
authors.forename: Richard I
authors.initials: RI
authors.lastname: Markowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000601:surgery*; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000601:surgery*; D055815:Young Adult