Emergency Exploratory Laparotomy For Midgut Volvulus With Intestinal Malrotation In Neonates Under Thoracic Segmental Spinal Anesthesia

Abstract

Introduction: Malrotation of the intestines is a developmental abnormality that permits spontaneous abnormal rotation of the midgut around the mesentery which present with intestinal obstruction. The most serious complication of malrotation is midgut volvulus can rapidly compromise the intestinal blood supply causing infarction. Thoracic segmental spinal anesthesia has been demonstrated as a safe and effective method and has been shown as beneficial in maintaining hemodynamic stability for these patients and reducing side effects encountered with general anesthesia.
Case History:

A case of 6 days old male baby, 2 kg by weight, presented a UNM children hospital with chief complaint of distended abdomen with bilious vomiting after every feed, unable to pass stool since birth. Preoperative work up and abdomen USG was done which suggest midgut volvulus with intestinal obstruction, severe dehydration with pre-renal failure. Preoperative resuscitation was done in NICU. Preoperative anesthetic checkup was done and planned for the emergency exploratory laparotomy under thoracic segmental spinal anesthesia. Patient was given Inj. Ketamine for sedation. Under aseptic precaution, thoracic segmental spinal anesthesia with isobaric Inj. Levobupivacaine with additive inj. Dexmedetomidine was given. O2 via facemask was given and patient was hemodynamically stable throughout the procedure and postoperatively.

Conclusion:
Midgut volvulus is a true surgical emergency. Surgery is only definitive treatment of malrotation and midgut volvulus. Thoracic segmental spinal anesthesia as a newer modality of induction is safe for major abdominal surgeries like exploratory laparotomy as it is associated with decrease perioperative opioid requirement, early recovery of bowel function, comparatively less post-operative respiratory complications which result in shorter length of hospital stay.