VOLVULUS MIDGUT

Indah Sari
Muhammad Nazif Syahrin
Sri Hartini

SUPERVISOR:
Dr. dr. Dewi A. Wisnumurti, Sp.A (K), IBCLC

PEDIATRIC DEPARTMENT OF
MEDICAL FACULTY OF RIAU UNIVERSITY
Introduction
Glasgow United Kingdom 60 children 39 newborn
Incidence
INDONESIA

RSUD Banda Aceh 2 case of newborn

Mortality 30 % Reduced 3-5 %

Risk Factor Intestinal malrotation

Prognosis management 1. Jurnalis YD, Soeyati Y, Ruelly A. 2013

2. Gingold D, Murell Z. 2012
3. Halabi WJ, Jafari MD, Kang CY. 2013
4. Wismayer R. 2017
2 5. Kitara DL, Wismayer R. 2015
Definition
condition where the small bowel (intestinal)
experience torsion due to malrotation during
fetal development in the uterus (intrauterine).

Etiology
Failure of rotation
< 1 year
Muscle weakness

1. Jurnalis YD, Soeyati Y, Ruelly A. 2013

6. Back SJ. Midgut volvulus imaging. 2018
3 7. Satija B, Kumar S, Kohli S. 2013
Pathophysiology

4
8. Bensard DD, Acker SN, Kulunowsky AM.2017
 Classification

Volvulus midgut Volvulus sekum Volvulus sigmoid

8. Bensard DD, Acker SN, Kulunowsky AM.2017

5 9. Khan AN, Macdonald S, Khattab YA, Howat JMT. 2016
Diagnosis

Diagnosis

Anamnesis Physical examination Adjunct examination

6. Back SJ. Midgut volvulus imaging. 2018

7. Satija B, Kumar S, Kohli S. 2012
10. Glick Y et al. 2018
11. Valsdottir E, Marks JH. 2008
6 16. World health Organization. 2005
 Treatment and Prognosis

Medical Therapy Therapy

Empiric Diagnose Prognosis

suportif Therapy
Therapy

12. Nuhu A, Jah A. 2010

13. Ingoe R, Lange P. 2012
7 14. Tidy C. 2015
CASE REPORT
 Identity
– Name : By. SBU
– No MR : 968648
– Address : Jl. Usaha II, Bangko, Rohil
– Religion : Islam
– Ethnic : Jawa
– Father : Mr. M
– Mother : Mrs. SBU
– Date of admission : 17th October 2017
– Date of examination : 17th November 2017
– Date of discharge : 19th November 2017
– Patient status : Alive
9
 Anamnesis
 Chief Complaint:

Neonates small for gestational age (SGA)

was 47 minutes old with preterm premature
rupture of membranes (PPROM) mother in 3
days.

10
 History of Present Illness

-Unstable VS & GDS - Lab : PRC transfusion

-NPO -Stable VS ,GDS,active
-2025-2130 gr - Good tolerance
-Antibiotic : second line -2325-2385 gr
-Klebsiella pneumonia ssp - Antibiotic
2nd week 4th week

-Unstable VS & GDS -Unstable VS & GDS -Stable and active

-NPO - Good tolerance -Good tolerance
-1840-1960gr - 2130-2320 gr -2420-2560 gr
- Antibiotic - Lab: TC transfusion -Antibiotic
11
1st week 3rd week 5th week
Pregnancy • Multigravida, 31-32 weeks, 2
times ANC in midwife.

History • History of vaginal discharge

• Mother 39 years old, SD,

Parents housewife, no income, BPJS.

History
• Father 45 years old, SD,
entrepreneur, income 1.5
million, BPJS.

Family • The oldest, 20th years old

History • The youngest, 2 month old
12
 • Multigravida, two times ANC
in midwife, SC history,
The Important untreated vaginal discharge
Things from history, green, thick and bad
odor amniotic fluid, PEB with
Mother +1 proteinuria and PPROM 3
days.

• Neonates, boys, 31-32

The Important weeks, 1840 gram, 35,0 0C,
Things from GDS 32 mg/dL, with infection
of Klebsiella pneumonia ssp.
Neonate
13
 Working Diagnosis

• Small for gestational age - Appropiate

for gestational age - low birth weight
• Moderate hypothermia with improvement
• Hypoglycemia with improvement
• Early onset of neonatal sepsis e.c
Klebsiella pneumonia ssp with
improvement
14
 Prognosis

 Quo ad vitam : Dubia ad bonam

 Quo ad functionam : Dubia ad bonam

15
Discussion
 Boy infant
USG 31─32 weaks gestation
Ballard score 27
Weight 1840 grams
Multigravida (G6P5A0H5)
Mother with PEB
THEORY
Infection of mother were of risk
factor on prematurity birth
CASE
Mother have vaginal discharge
history which was not cure
THEORY
There are 1 major risk factor and 2
minor risk factors are become SNAD
Case
rupture of membranes over 18
hours
gestational age 31-32 weeks
Discharge on mother is untreated
- Risk factors
Intake during treatment is
- Symptoms : hypothermia,
hypoglycemia, vomiting, intoletance formula milk because of
drinking, abdominal bloating poor maternal breast intake
- laboratory : thrombocytopenia,
high of ratio IT, blood cultures
found Klebsiella pneumonia ssp
THEORY
Hight of Ratio IT caused by gram
negative bacteria. Increase of weight per day
based on WHO is 20-30 grams.
Case
Blood culture showed sensitivity to
Fosfomycin and tygecycline Infant treatment at 33 days,
weight gain to 720 grams .
Antibiotic is 21 days, based on
treatment and dose in meningitis
therapy. Infants should be routinely
controlled to health facility to
In proven sepsis should be do know the infant’s growth and
lumbal punction to know development is optimal or not
bakteremia. and get immunization on
Showed of the development : an
schedule
active baby, good tolerance
drinking, weight
17 gain, and
improvement of laboratory
THANK YOU