Hypothesis The Ladd procedure for malrotation predisposes children to postoperative intussusception (POI).
Design Retrospective case-control review.
Setting University-affiliated tertiary care pediatric hospital.
Patients Five of 159 patients undergoing the Ladd procedure between 1995 and 1998 developed POI. Predisposing factors were sought by comparison with age-matched controls who underwent the Ladd procedure during the same period. The entire Ladd group was compared with all 1717 patients undergoing any other laparotomy during the same period for incidence of POI.
Main Outcome Measures Differences in weight, percentile weight, age, length of nasogastric suction, time to oral intake, and length of stay between Ladd patients developing POI and age-matched controls from the Ladd group were compared using the Mann-Whitney U test. Incidence of POI after the Ladd procedure and "other laparotomy" was compared using 
2 analysis.
Results In the Ladd group, there were 5 cases of POI (3.1%). There was 1 case of POI (0.05%) after all other laparotomies (P<.001). Symptoms developed at a mean±SD of 7.2 ± 2.1 days. Upper gastrointestinal tract with small bowel follow-through showed partial bowel obstruction in 4 cases and was normal in 1 case. Reexploration took place at a mean±SD of 9.2 ± 2.8 days. Children developing POI after undergoing the Ladd procedure were less likely to be small for their age (P=.03) than age-matched controls undergoing the Ladd procedure.
Conclusions The Ladd procedure predisposes children to POI. Aggressive investigation, including reexploration, should not be delayed if a child has symptoms of prolonged ileus within 2 weeks after undergoing a Ladd procedure.
