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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
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
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
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
abdominal wall defect
Abdominal Wall Defect

Omphalocele

Gastroschisis

slide19
Wilms tumor
  • asymptomatic abdominal mass
  • Well baby
  • rapid abdominal enlargement ( pain, fever, and gross hematuria). 2 to hemorrhage
  • Treatment is surgical resection
slide20
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
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