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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