Dr-Hamdi Al-maramhy
Transcript of Dr-Hamdi Al-maramhy
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Dr-Hamdi Al-maramhy
(FRCS,SBGS,ABGS,SBPS,ABPS,EBPS)
Ass. Prof & Consultant general and pediatric surgery
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Neonatal Intestinal obstruction
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introduction
99% of healthy full-term infants pass their first stool or meconium within 24
hours of birth .
all healthy term neonates should do so by 48 hours.
With preterm infants the length of time can extend up to 9 days.
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Is it important?
One of the commnest diagnosis .
Delay may lead to:
-dehydration& hypovolemia.
-respiratory complications.
-metabolic acidosis.
-perforation/ gangrene.
-septicemia.
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CAUSES:
pathophysiological
intrinsic developmental defects
abnormalities of peristalsis .
abnormal intestinal contents.
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Clinically
high Duodenal
obstruction(atresia ,stenosis,anular
pan.)
Malrotation and volvulus .
jeujenal atresia .
low
Meconium plug syndrome.
Anorectal malformations.
Hirschsprungs disease.&NID.
Small left colon syndrome.
Colonic atresia.
Meconium ileus.
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Evaluation of neonatal intestinall obstruction
History and clinical
examination.
Investigation
Treatment
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History
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examination
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investigation
Plain abdominal x-ray
? High or low
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Upper intes. Obstruction
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Lower intest. obstruction
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Ba enema
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D.A
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D A
Presentation
- presents with bilious vomiting shortly after
birth(1-2day).
-scaphoid abdomen, epig. fullness
Diagnosis
("double bubble").
Management:
duodeno-duodenostomy,
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Malrotation
Clinical Presentation:
Sudden onset of bilious emesis
Abdominal distention is common but may be absent.
Abdominal tenderness varies.
On rectal examination, stool, if present, is guaiac positive
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MALROTATION
Midgut volvulus with necrosis is disasterous
Must consider in every infant with bilious emesis.
30% present within first week of life.
50% within first month.
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Malrotation
• Surgical Management:
Ladd’s procedure
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Ileal and Jejunal Atresia
Etiology:
Associated Conditions:
low birth weight (40%)
low incidence of other anomalies are noted. Small bowel atresia is associated with meconium ileus.
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JA
• Clinical Presentation:
• Diagnosis:
• Management:
• Laparotomy :with resection
of the proximal dilated end.
End-to-end anastomosis .
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lIeal and Jejunal Atresia
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Meconium Ileus
incidence:
types;
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MI
Clinical Presentation :
b) generalized abdominal distension, bilious vomiting, and
failure to pass meconium in the first 24 to 48 hours after
birth.
c) A family history of cystic fibrosis .
a)maternal history of polyhydramnios is present in 20 % of
patients.
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MI
Management:
Multipl enemas may be required.
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MI
• Surgical Treatment;
i) the meglumine diatrizoate enemas do not relieve the obstruction.
ii) The infant appears too ill to delay operation.
iii)complicated MI.
iv) The diagnosis of meconium ileus is uncertain.
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Hirschsprung's Disease
Incidence; 1:5000 live births
Etiology:
is the absence of ganglion cells in the lower rectum.
This leads to ineffective conduction of peristalsis, resulting in a functional obstruction.
The aganglionic segment may extend more proximally and can involve the entire colon.
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HIRSCHSPRUNG’S DISEASE
Presentation;
Failure to pass meconium
within 48 hrs.
• Episodic abdominal distention, overflow diarrhea, severe constipation
Non-specific sxs in older infant
and child:
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WORK-UP of HD
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OPERATIVE MANAGEMENT OF HD
• Procedure; pullthough
• Traditional:
• recently: Trend to avoid colostomy;
• Laparotomy.
• Anal.
• Laparoscopic.
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HIRSCHSPRUNG’S ENTEROCOLITIS?
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PRESENTATION OF ENTEROCOLITIS
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Imperforate Anus
• The incidence ; 1 in 5000 live birth.
• Ass. Anomalies VACTERL.
OLD CLASSIFICATION;
RECENT ONE
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Presentation
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Thank you
?