Tuesday, July 4, 2017

Pediatric surgery Intestinal Obstruction 1

Surgery for Intestinal Obstruction
Definition
In cases of intestinal obstruction due to developmental defect the newborns, resulting in:
   Abdominal distension
   Bilious vomiting
   Constipation.
Objectives
   To respect the adynamic and the dilated proximal bowel
   To restore intestinal continuity, with or without an external stoma.
Position
Supine (with an overhead warmer).
Anesthesia
General with endotracheal intubation.
Procedure
1.  Transverse abdominal muscle cutting incision 7-10 cm long between the umbilicus and the xiphoid process.
2.  Open the peritoneal cavity.
3.  Identify the site of obstruction.
4.  Resect or taper the grossly dilated proximal segment of the bowel.
5.  Make a cutback for 2 cm on the antimesenteric side of distal narrow segment of the bowel.
6.  Make a single layer anastomosis with 5/0 silk interrupted sutures between the proximal and the distal bowel segments.
7.  Ensure distal patency of the small and large bowel.
Options
1. Bishop-Coop Chimney instead of primary anastomosis.
2.  Exteriorization of proximal and distal ends of bowel.
3.  Plication of the dilated proximal bowel.
Instruments
General pediatric set.
Sutures
   4/0 Catgut              2
   5/0 Silk                               2
•           5/0 Nylon                    1

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