Second-Look Operation With Silo Suspension Method for Midgut Volvulus Complicated by Intestinal Ischemia and Abdominal Compartment Syndrome

Abstract

Midgut volvulus with bowel ischemia was treated with a silo suspension method (SSM) following Ladd’s procedure. This method enabled us to observe the ischemic bowel under direct vision while avoiding abdominal compartment syndrome (ACS). We experienced treating three neonatal cases where a second-look operation was performed after the SSM. In the first case, the SSM was performed in response to ACS that developed the day after Ladd’s procedure. Postoperatively, we observed the degree of edema and necrosis in the bowel within the silo. Subsequently, on the sixth postoperative day, after the general condition had improved, 40 cm of necrotic bowel was resected. In the second and third cases, the SSM was performed during Ladd’s procedure. In both cases, necrotic bowel segments of 25 cm and 35 cm were resected on the second postoperative day, respectively. The postoperative course was favorable in all three cases.The SSM has the following advantages: (1) it prevents ACS associated with abdominal closure, (2) it enables the determination of the timing of the second-look operation by observing the bowel under direct vision, and (3) it minimizes the extent of bowel resection. It is useful for midgut volvulus without worsening morbidity because of factors such as increased infection risk.