Superior Mesenteric Vein Dilatation With Ladd’s Band Causing Partial Intestinal Obstruction in a Five-Year-Old Male Child: A Case Report

Midgut malrotation has a noticeable frequency among congenital anomalies and presents mostly as vomiting. We report a case of a five-year-old boy with recurrent attacks of bilious vomiting and mild epigastric colicky abdominal pain for a year. Midgut malrotation with Ladd's band and superior mesenteric vein (SMV) dilatation causing partial intestinal obstruction were diagnosed based on the clinical presentation, upper gastrointestinal (GI) barium follow-through study, computed tomography (CT) scan with and without IV contrast, and intraoperative findings. In the upper GI barium study, the duodenum was passing anteriorly, and the second and proximal third portions were persistently dilated with recurring to-and-fro type peristalsis, resulting in delayed passage through the third portion. In the abdomen and pelvis CT scan with and without IV contrast, the SMV was dilated, forming a venous collar around the third portion of the duodenum and causing partial obstruction. Exploratory laparotomy revealed a hugely dilated SMV trapped in the Ladd’s band. Ladd’s procedure was done besides releasing the SMV and widening the root of the mesentery. The postoperative follow-up was smooth, without any relapse of the previous symptoms. Midgut malrotation in the older age group is rare in itself because there are relatively few cases documented in this age range. We determined to present this case to raise awareness of knowledge concerning the diagnosis and timely management of this condition in order to prevent comorbidity. In addition, we realise that SMV dilatation is an uncommon correlation of the known condition, midgut malrotation, and hope to contribute to the literature.