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నైరూప్య

Are Intussusceptions More Common and Severe in Malrotation? - Waugh Syndrome

Parveen Kumar, Shandip Kumar Sinha and Yogesh Kumar Sarin

Waugh syndrome-The association of intussusception and malrotation is often overlooked and underdiagnosed. Malrotation need to be diagnosed preoperatively (reversal of SMA and SMV axis on doppler) or atleast looked for intraoperatively. Here is reported a case of 8 month old male child brought with complains of pain abdomen associated with fever since 4 days and passing red current like stools since last 2 days. No history of preceding diarrhoea. Parents gave history of something coming out of rectum while crying in pain since one day. Physical examination revealed mild pallor, tachycardia with distended abdomen and decreased bowel sounds. Per rectal examination showed prolapsed congested mass. Child was taken for emergency right supraumbilical transverse laparotomy and revealed mobile ascending colon and duodeno-jejunal flexure on right side of midline, with a long intussusception of terminal ileum, appendix and cecum into transverse colon, descending colon and rectum. Standard reduction was tried and it was possible to reduce it till transverse colon. Enterotomy was made into mid transverse colon to facilitate reduction of small bowel. On reduction, terminal ileum, appendix and ascending colon were not viable and was resected. In view of sepsis, ileostomy and distal stoma were made. Child had uneventful post-operative course and stoma was reversed at 6 weeks.