Ladd’s bands

The main causes for a double bubble are duodenal atresia, annular pancreas, and midgut volvulus. Less frequently it may be secondary to duodenal web, Ladd s band, or preduodenal portal vein (Crowe and Sumner 1978). 

Partial duodenal obstruction may be produced by duodenal stenosis, duodenal web, Ladd s bands, midgut volvulus, annular pancreas, preduodenal portal vein, and duplication cyst. Plain radiographs show gaseous distension of the stomach and duodenum with a normal or diminished quantity of air in the small bowel. Content studies may be necessary to differentiate between midgut volvulus and partial duodenal obstruction caused by a web or stenosis (Auringer and Sumner 1994). Sonography is helpful to rule out extraluminal causes such as a duplication cyst. 

A patient with malrotation may also develop dense peritoneal bands, termed Ladd s bands, that originate in an attempt to fix the bowel. These bands extend from the cecum to the hilum of the liver, posterior peritoneum, or abdominal wall across the duodenum and can cause extrinsic duodenal obstruction. 

Obstruction due to Ladd s bands produces a Z-shaped configuration, outlining the lack of normal rotation and fixation of the duodenum. The Z-configuration may appear similar to the corkscrew of volvulus, but it does not indicate volvulus itself (Fig. 1.12). It must be stressed, however, that in most children with malrotation obstruction is caused by the volvulus with the band playing a lesser role or no roll at all (Ford et al. 1992 Torres and Ziegler 1993). 

Fig. 1.12a,b. Malrotation with z-shape of the duodenum and jejunum. Upper gastrointestinal series. Anteroposterior (a) and lateral (b) projections show a central, downward, Z course of the duodenum. No volvulus was found at surgery. Surgery demonstrated the partial obstruction to be produced by Ladd s bands... 

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See also in sourсe #XX -- [ , , ]

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