Bowel Obstruction: Infants and Children Age specific: Adhesions, Malrotation, intusception,...
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Transcript of Bowel Obstruction: Infants and Children Age specific: Adhesions, Malrotation, intusception,...
Bowel Obstruction: Infants and Bowel Obstruction: Infants and ChildrenChildren
• Age specific:
• Adhesions, Malrotation, intusception, meckel’s, appendicitis (“febrile obstruction”)
• Hx + Physical much closer to adults
PresentationPresentation
Four cardinal signs of intestinal obstruction in neonate1. Antenatal polyhydramnios2. Bilious vomiting3. Delayed passage of
meconium (> 24 hrs)4. Gastric residual > 30 cc
Cardinal sing in adult1. Vomiting2. Abdominal pain3. Abdominal distension4. Obstipation/ constipation
Perioperative ManagementPerioperative Management
• Fundamental rule: previous losses /maintenance/ongoing needs
• Urine output best measure of adequate resuscitation• ?Need for central monitoring if problematic• Recall distribution of various IV solution• Bolus: as per PALS (20 cc/kg)• Titrate to heart rate, urine output BP• ↑ Maintained 25% for each quadrant of abdomen involved• Antibiotics if any viscus opened, cardiac issues,
immunosuppresed (newborn)• Steroids: if on previously/deficiency (stress dose physiology)• Nasogastric tube (Decompression)• Keep patient warm
Be Aware of Child with Be Aware of Child with Bilious (Green) VomitingBilious (Green) Vomiting
MalrotationMalrotation
• 10th Week of Development rapid growth of intestine which returns to abdominal cavity with rotation
• Problems can occur at any of the 3 stages– Duodenal rotation– Elongation and fixation of the
mesentery– Rotation of the colon
Tracheo-esophageal fistulaTracheo-esophageal fistulaPresentationPresentationMaternal polyhydramnios on U/S Maternal polyhydramnios on U/S Drooling, choking, coughing, cyanosis with Drooling, choking, coughing, cyanosis with feeding feeding tracheomalacia tracheomalaciaNo passage of NG tube No passage of NG tube
VACTERL(Vertebral, anal, cardiac, tracheal, (Vertebral, anal, cardiac, tracheal, esophageal, renal, limb)esophageal, renal, limb)
Work-upComplete physical examComplete physical examCXR, AXR – vertebral / rib anomaliesCXR, AXR – vertebral / rib anomaliesEchocardiogram – aortic arch L vs. R to plan Echocardiogram – aortic arch L vs. R to plan incisionincisionRenal U/SRenal U/SCT head in selected patientsCT head in selected patients
Pneumonitis prevention and treatmentPneumonitis prevention and treatmentParenteral antibiotics – gentamicin, ampicillinParenteral antibiotics – gentamicin, ampicillinSump suction catheter (Replogle)Sump suction catheter (Replogle)
Treatment surgical repair
Meckel’s Diverticulum'sMeckel’s Diverticulum's• True diverticulum's• Result from persistence vitelline
duct and the omphalomesenteric duct.
• Incidence 2%, Most of these people remain asymptomatic throughout life.
• Role of 2.
• Complication: hemorrhage, acute diverticulitis, perforation, and small bowel obstruction or
intussusception
IntussusceptionIntussusception
Duodenal Atresia/ Annular Duodenal Atresia/ Annular PancreasPancreas
• Primary problem is one of recanalization of solid duodenum.
• Obstruction typically at level of common bile duct and pancreas
• Associated anomalies common: almost 50%– Down syndrome 29%– malrotation 19%– congenital heart disease 17%– TEF 7%– Others (renal, respiratory, imperforate
anus - roughly 10%)
Jejunal & Ileal AtresiaJejunal & Ileal Atresia• Pathology related to late
second trimester vascular accident (Barnard)
• Associated anomalies rare • Classification system
Imperforated AnusImperforated Anus
Hirschsprung’sHirschsprung’s
Meconium IleusMeconium Ileus
NECNEC
Abdominal Wall DefectAbdominal Wall Defect
Omphalocele
Gastroschisis
Wilms tumor
asymptomatic abdominal massWell babyrapid abdominal enlargement ( pain, fever, and gross hematuria). 2 to hemorrhage Treatment is surgical resection
Neuroblastoma cells are derived from the primitive neural crestIt was found that patients with an increased number of copies of the N-myc gene had a much worse prognosisSite: adrenal, retroperitoneum, mediastinum & neck.Treatment: surgery +/-chemotherapy
Neuroblastoma
Duplication Cyst
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