Diagnostic Process in a Late Diagnosis of Ladd’s Syndrome in a 4-Year-Old Girl With Edwards Syndrome: A Case Report

Congenital anomalies affect 2–5% of newborns, with gastrointestinal malformations accounting for 5–6% of cases. Intestinal malrotation is a developmental disorder caused by incomplete rotation and fixation of the midgut between the 5th and 10th week of gestation. It is usually diagnosed in the neonatal period, often prenatally or within the first year of life, with more than 90% of cases identified before the age of 1. Late presentation in older children is therefore uncommon and diagnostically challenging. This case report describes an unusual late diagnosis of malrotation with Ladd’s bands in a 4-year-old girl. The aim is to emphasize that congenital gastrointestinal anomalies should remain part of the differential diagnosis of vomiting in children of any age. We report the case of a 4-year-old girl with Edwards syndrome presented with five days of coffee ground vomiting after each attempt to drink. The patient has not passed stool for one week. Ultrasound was inconclusive, and X-ray suggested right-sided diaphragmatic hernia with obstruction. A laparotomy was performed to resolve the intestinal obstruction and repair the diaphragmatic hernia. During the intraoperative bowel inspection, intestinal malrotation and associated Ladd's bands, causing duodenal obstruction, were identified. The Ladd's bands were released, and Ladd's syndrome was diagnosed. This case highlights the rare late presentation of Ladd’s syndrome in a 4-year-old child. It underlines the need to consider intestinal malrotation in the differential diagnosis of acute vomiting and bowel obstruction at any pediatric age, even when symptoms are nonspecific.