Chang HK, Hong YJ, Oh J-T, Choi SH, Han SJ - PowerPoint PPT Presentation

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Chang HK, Hong YJ, Oh J-T, Choi SH, Han SJ

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  1. Case Report of Gastric Outlet Obstruction from GastrogastricIntussusception with External Web of Stomach in Neonate Chang HK, Hong YJ, Oh J-T, Choi SH, Han SJ Department of Pediatric Surgery, Severance Childrens’ Hospital, Yonsei University College of Medicine

  2. Case Presentation 10 days / male Chief Complanit : abdominal distension for 5days NSVD at 35+2 wks with birth weight of 2.24 kg d/t PROM APGAR 1’-7, 5’-8 ASD 2’ 3.5-4mm (improved 2wks later) Abdominal sono at 2 days after birth : WNL Abdominal distension at 6 days after birth Enema resulting small amount of hard stool passing without improvement of abdominal distension NPO, IV hydration & decompression via gavage tube

  3. Simple Abdominal X-ray at birthday

  4. Simple Abdominal X-ray at 6 days after birth Marked distention of stomach Large air fluid level at stomach without evidence of free air

  5. UGI at 8 days after birth Complete outlet obstruction of stomach r/o impaction of lactobezoar r/o other cause of outlet obstruction such as spasm or volvulus – less likely

  6. Abdominal Ultrasonography & CT at 10 days after birth Gastric outlet obstruction r/o gastroduodenal or gastrogastricintussusception

  7. Abdominal Ultrasonography at 10 days after birth

  8. Operative Findings Broviac catheter insertion Gastric outlet obtruction from gastrogastric retrograde intussupection triggered from thin triangular-shaped membranous structure attached on anterior wall of antrum across the lesser curvature and greater curvature of stomach : manual reduction & excision Adhesion between stomach and peritoneum Very thin whole gastric wall from the uncorrected distension Linear longitudinal perforation of gastric wall along the greater curvature about 3cm in length : primary repair Irrigation and drainage

  9. Operative Findings

  10. Postoperative Progress Abdominal X-ray at POD#1 UGI at POD#8

  11. Postoperative Progress UGI at POD#15 3 hrs after 2nd UGI

  12. Postoperative Progress 3 days after 2nd UGI 4 days after 2nd UGI 2 months after operation

  13. Conclusions Gastric outlet obstruction with gastrogastricintussusception was occurred from thin triangular-shaped membranous structure attached on anterior wall of antrum across the lesser curvature and greater curvature of stomach. Although gastric outlet obstruction is not common in neonate, this anomaly of stomach should be considered as one of the cause of gastric outlet obstruction in neonate. Perforation of gastric wall occurred from distended stomach with gastric outlet obstruction because the distended stomach was not successfully decompressed preoperatively. Gastrogastricintussusception was reduced and not recurred by excision of external web of stomach which was considered as a lead point of intussusception.