# Late-onset midgut volvulus 8 years following a neonatal omphalocele repair: a case report and review

## TL;DR

A child with a history of a repaired omphalocele developed a rare intestinal obstruction 8 years later, highlighting the need for long-term monitoring and preventive measures.

## Contribution

This case report highlights the rare complication of late-onset midgut volvulus following neonatal omphalocele repair and discusses the potential role of prophylactic Ladd’s procedure.

## Key findings

- An 8-year-old boy with a prior omphalocele repair developed midgut volvulus due to Ladd’s bands.
- Emergency surgery with a Ladd’s procedure resolved the obstruction successfully.
- The case emphasizes the importance of long-term follow-up and early suspicion in similar patients.

## Abstract

Omphalocele is a congenital abdominal wall defect. It is frequently associated to other anomalies such us intestinal malrotation, though this is frequently underdiagnosed. We report a rare case of an 8-year-old boy with a history of neonatal surgery for a small type I omphalocele. The child was asymptomatic since his neonatal primary repair. Presented acutely with signs of intestinal obstruction. Imaging suggested high-grade obstruction, and emergency laparotomy revealed a midgut volvulus caused by tight Ladd’s bands around a narrowed mesenteric base. A Ladd’s procedure was performed, including detorsion, band division, bowel repositioning, and prophylactic appendectomy. The patient recovered uneventfully. This case highlights the potential for late-onset volvulus in patients with prior omphalocele repair, underlining the importance of long-term follow-up and a high index of suspicion in acute presentations. It also raises considerations regarding the prophylactic role of Ladd’s procedure during initial repair, especially in settings equipped for ongoing surveillance.