پروفسور محمد حسین سلطان زاده

      استاد دانشگاه علوم پزشکی شهید بهشتی
     متخصص کودکان ونوزادان
        طی دوره بالینی عفونی از میوکلینیک آمریکا
دبیر برگزاری کنفرانس های ماهیانه گروه اطفال
 دانشگاه علوم پزشکی شهید بهشتی

 آقای دکتراحمد خالق نژاد
فوق تخصص  جراحی اطفال و
 استاد دانشگاه  بیمارستان مفید
مرکز تحقیقات جراحی اطفال بیمارستان مفید

دکتر سید محمد هادی امامی فر
رزیدنت بیمارستان مفید

دکتر محسن سنجری
رزیدنت بیمارستان امام حسین

 تشخیص

Late Jejunoileal atresia

دکتراحمد خالق نژاد

Neonatal intestinal obstruction

1- The immediate group

2- The intermediate group

3- The elective  group

The immediate group

Conditions require immediate investigation and/or a definitive operation.

A particular important subgroup is neonatal emergencies.

Trauma, acute infections, abdominal emergencies  acute scrotal conditions.

Neonatal emergencies

Most of these are the result of developmental abnormalities.

Developmental abnormalities causing:

Disorder of function.

Threaten life.

The best prognosis depends on:

Early diagnosis.

Speedy transport.

Effective surgical management.

Developmental anomalies

Affect the patients in three ways.

Anomalies causing obstructive, destructive and other consequences before birth.

Congenital diaphragmatic hernia.

Posterior urethral value.

Well-tolerated abnormalities without significant effect in utero.

Unruptured exomphalos.

Esophageal atresia.

Latent abnormalities.

Submucosal cleft palate.

Infection in urinary tract malformation.

 

دکتر سید محمد هادی امامی فر

lWhen a neonate develops bilious vomiting, one should suspect a surgical condition
lAfter a focused physical examination, a nasogastric or orogastric catheter should be placed for gastric decompression to prevent further vomiting and aspiration. This should be done before any diagnostic or therapeutic maneuvers are performed.
lWhen the patient is hemodynamically stabilized, appropriate imaging studies of the abdomen should be performed. These would include plain abdominal films and/or contrast studies

Intestinal obstruction with bilious vomiting in neonates can be caused by

lduodenal atresia,
lmalrotation and volvulus,
l jejunoileal atresia,
lmeconium ileus,
land necrotizing enterocolitis

Duodenal atresia

lCause and incidence

Embryogenic; occurs in 1 per 5,000 live births; 25% have Down syndrome

lAge of onset and presentation

Few hours after birth; billious vomiting, no distention

lDiagnostic procedure and findings

Abdominal film, "double-bubble" sign

lPreoperative management interval before surgery

Nasogastric suction, IV fluids; 24 to 48 hours

Malrotation with volvulus

lIncomplete bowel rotation occurring during 7th to 12th weeks of gestation
lAt 3 to 7 days; bilious vomiting, rapid deterioration with volvulus
lUpper GI spiral sign on ultrasound; abnormal location of the superior mesenteric vessels
lNasogastric suction, IV fluid; STAT surgery for symptomatic patients, within days for others

Jejunoileal atresia

lMesenteric vascular accident during fetal life in 1 per 3,000 live births
lWithin 24 hours of birth; vomiting, abdominal distention
lAir-fluid levels on abdominal film
lNasogastric suction, IV fluids; 12 to 24 hours

Necrotizing ileus

lCause unknown in 2.4 per 1,000 live births

l10 to 12 days after birth; distention, vomiting, bloody stools

lAbdominal film; distention, pneumatosis, air in the aortal vein

lNasogastric suction, IV fluids, nutrition, antibiotics for 10 days. When perforated, immediate surgery

Meconium ileus

lGenetic, occurs in 15% of newborns with cystic fibrosis, and in 1 per 5,000 to 10,000 live births

lImmediately after birth; abdominal distention, bilious vomiting

lAbdominal film; distention, air-fluid levels, sweat test, "ground-glass" sign

lDecompression

lMeconium ileus is characterized by retention of thick tenacious meconium in the bowel (ileum, jejunum or colon), which results in bowel obstruction.
lmucus plugs may be evacuated after withdrawal of the examination finger.
lThe plain abdominal films show distended loops of intestine with thickened bowel walls.
l A large amount of meconium mixed with swallowed air produces the so-called "ground-glass" sign, which is typical of meconium ileu

lWhen a Gastrografin enema is unsuccessful, laparotomy is indicated to evacuate the obstructing meconium by enterotomy irrigation. Immediate surgery is indicated in patients with complicated meconium ileus. Bowel resection for perforation and/or obstruction related to kinking of the bowel is indicated, usually requiring a temporary enterostomy.

 

دکتر محسن سنجری