Ladd's band - a case report

Introducton: Ladd bands consist of a congenital pathology of peritoneal embryogenesis characterized by the formation of a fibrotic area between bowel loops that, combined with a malrotation of the bowel, can cause intestinal obstruction or in other cases, facilitate the development of the volvulus. Because it is congenital, it has a predominance in childhood and its diagnosis must be early, so that surgical correction can be performed on an urgent basis, given the high risk of vascular involvement and intestinal necrosis. Objectives: The objective of this paper was to report a case of intestinal obstruction by Ladd's bands in a patient and the treatment used. Methods: The present study consists of an exploratory research of qualitative approach for a case report from the Santa Casa de Misericórdia de Fernandópolis-SP, performed from the medical record of a patient with a characteristic picture for intestinal obstruction by Ladd's band and literature review. Results A 13-year-old male presented at the Emergency Department of Santa Casa de Misericórdia in Fernandópolis, São Paulo, Brazil, complaining of vomiting for 3 days, accompanied by intense abdominal pain, lack of intestinal transit for gas and feces, and anorexia, consistent with a picture of intestinal obstruction. He also reported a history of appendectomy 7 years ago. On physical examination, he appeared underweight and dehydrated. The abdomen exhibited no visual abnormalities on inspection; however, it was tender to deep palpation in the mesogastric region, without signs of peritoneal irritation, and with diminished hydro-aerial sounds. Digital rectal examination yielded no changes. The patient underwent a laparotomy during which an ileodistal dissection was performed. Following 10 days of postoperative care and improvement in his condition, he was discharged from the hospital.. Conclusions: Surgery stands as the preferred approach due to the heightened risk of vascular compromise and intestinal necrosis. Therefore, any patient with symptomatic malrotation should undergo urgent surgical intervention. Currently, this procedure can be carried out via laparoscopy, a secure and minimally invasive approach for adult patients without midgut volvulus. Surgical treatment remains the primary modality, regardless of the age of presentation. Early diagnosis of this congenital anomaly is the pivotal step in enhancing the patient's quality of life