Bowel obstruction infants and children
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Bowel Obstruction: Infants and Children. Age specific: Adhesions, Malrotation, intusception, meckel’s, appendicitis (“febrile obstruction”) Hx + Physical much closer to adults. Presentation. Four cardinal signs of intestinal obstruction in neonate Antenatal polyhydramnios Bilious vomiting

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Bowel Obstruction: Infants and Children

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Bowel obstruction infants and children

Bowel Obstruction: Infants and Children

  • Age specific:

  • Adhesions, Malrotation, intusception, meckel’s, appendicitis (“febrile obstruction”)

  • Hx + Physical much closer to adults


Presentation

Presentation

Four cardinal signs of intestinal obstruction in neonate

  • Antenatal polyhydramnios

  • Bilious vomiting

  • Delayed passage of meconium (> 24 hrs)

  • Gastric residual > 30 cc

  • Cardinal sing in adult

  • Vomiting

  • Abdominal pain

  • Abdominal distension

  • Obstipation/ constipation


Perioperative management

Perioperative 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 bilious green vomiting

Be Aware of Child with Bilious (Green) Vomiting


Malrotation

Malrotation

  • 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 fistula

Tracheo-esophageal fistula

  • Presentation

  • Maternal polyhydramnios on U/S

  • Drooling, choking, coughing, cyanosis with feeding  tracheomalacia

  • No passage of NG tube

  • VACTERL

    • (Vertebral, anal, cardiac, tracheal, esophageal, renal, limb)

  • Work-up

    • Complete physical exam

    • CXR, AXR – vertebral / rib anomalies

    • Echocardiogram – aortic arch L vs. R to plan incision

    • Renal U/S

    • CT head in selected patients

  • Pneumonitis prevention and treatment

    • Parenteral antibiotics – gentamicin, ampicillin

    • Sump suction catheter (Replogle)

      • Treatment surgical repair


  • Meckel s diverticulum s

    Meckel’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


    Intussusception

    Intussusception


    Duodenal atresia annular pancreas

    Duodenal Atresia/ Annular Pancreas

    • 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 atresia

    Jejunal & Ileal Atresia

    • Pathology related to late second trimester vascular accident (Barnard)

    • Associated anomalies rare

    • Classification system


    Imperforated anus

    Imperforated Anus


    Hirschsprung s

    Hirschsprung’s


    Meconium ileus

    Meconium Ileus


    Bowel obstruction infants and children

    NEC


    Abdominal wall defect

    Abdominal Wall Defect

    Omphalocele

    Gastroschisis


    Bowel obstruction infants and children

    Wilms tumor

    • asymptomatic abdominal mass

    • Well baby

    • rapid abdominal enlargement ( pain, fever, and gross hematuria). 2 to hemorrhage

    • Treatment is surgical resection


    Bowel obstruction infants and children

    Neuroblastoma

    • Neuroblastoma cells are derived from the primitive neural crest

    • It was found that patients with an increased number of copies of the N-myc gene had a much worse prognosis

    • Site: adrenal, retroperitoneum, mediastinum & neck.

    • Treatment: surgery +/-chemotherapy


    Bowel obstruction infants and children

    Duplication Cyst


    Bowel obstruction infants and children

    Question?


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