Professional Documents
Culture Documents
and Children
Surgery II
SURGERY II
FACILITATOR: Ma. Celine A. Villegas, M.D.
-
DATE: September 5, 2016
DUODENAL ATRESIA
Embryology
Embr
Clinical Picture of Duodenal Atresia Operative Management of Duodenal Atresia
Bilious Vomiting Depends on the intraoperative findings;
Bile is secreted at the level of the duodenum Principle bypass obstructed segment
Mild Epigastric Distention Duodenoduodenostomy
*resection
Duodenoduodenostomynt of
INTESTINAL ATRESIA
Embryology
Vascular accident in Utero
o Volvulus or Intussusception *end-to-end anastomosis
Incidence:1:330 to 1:1,500 live births o
f Duodenal Atresia MALROTATION
Clinical Picture of Intestinal Atresia
*this is the most dangerous
Vomiting
Abdominal Distention Embryology
Non-passage of Meconium Normal Intestinal Rotation
Operative Management of Duodenal Atresia o Usually at the 4th week of life
Diagnosis of Intestinal Atresia o Return of GIT in the abdomen
o From powerpoint: At 4th week AOG, normal
Plain Abdominal X-rays
occurrence of return of fetal GIT from
Dilated loops of Bowel with differential air-
extraembryonic coelom back into the abdomen.
fluid levels
Bowel undergoes rotation and fixation at certain
Barium Enema Microcolonof
parts of posterior abdominal wall
o If the process is incomplete or deviated from
normal, MALROTATION results.
Diagnosis of Malrotation
Barium Enema (cecum at right upper )
Red arrow pointing to the Ladds band between the duodenum and
cecum
Ladds Procedure
o Untwisting the bowel
Abdominal Colic
Vomiting
Currant Jelly stool---(Kids, itaga po to sa long
term memory. Say it with me Intu Currant Jelly
Repeat 10x)
Abdominal Distention Late
Hypovolomic Shock Very Late
Period of quiscence when peristalsis stops for a time
o Recurs (peristalsis as the GIT tries to propel
the bowel content resulting into currant jelly
stools
INTUSSUSCEPTION
Diagnosis
Physical Exam
o Palpable tubular massat right
hemiabdomen
o Rectal Exam : No stool in the rectum, only
bloody mucus
o Irritable, Lethargic baby Contrast Enema
o Marked abdominal distentionLATE o Coiled Spring Sign
Diagnostic Studies o Diagnostic and Therapeutic
Plain Abdominal X-ray o Contrast material will push the
o Dilated Bowel Loops intussusception and straighten out the
o Airless Right Lower Quadrant GIT
o Indicative of Intestinal Obstruction
o Lateral View:Differential air fluid levels
Contrast Enema
Reduction of Intestines
o Air (Pneumatic Reduction)90% reduction
rate; most successful
o Saline (Hydrostatic Reduction)
o Barium
Instillation per Rectum can Straighten out Intestine
Reduction Success Rate
o 42-80% Saline/Barium Reduction
o 90% Penumatic Reduction
Diagnosis
In males, where is meconium coming from?
o Male, low typemeconium on the perineal
skin
IMPERFORATE ANUS
A perineum without an anal opening---very common
Most anorectal malformations communicate by a
fistulous tract to the urinary or genital systems or
alternatively open to the skin of the perineum---
sometimes parents would note that stool comes out
of the vagina
1:5,000 live births
males>females
rectal/high lesions more in males
anal/low lesions more in females
Ultrasound or MRI
o Location of distal rectal pouch
Accurate determination of level of lesion of
imperforate anus will have bearing in management
Operative Management
Low Type
o Definitive treatment in neonatal period
o Anoplasty
High Type
Imperforate anus-female-low type o Definitive treatment at later date
1. Initial colostomy
X-ray 2. PSARP (Posterior Sagittal
o Determine the type of imperforate anus and Anorectoplasty)
to identify any congenital anomalies that are 3. Closure colostomy
present---patients with imperforate anus
occasionally has VACTRL anomaly
V- Vertebra
A- Anus
C- Cardiac
T- Tracheoesophageal fistula
E-Esophageal
R-Renal and Radial
L- Limb
o Invertogram/rice-wangsteen prone cross
table lateral
Pagtatapos
References: 2016 transcription | recordings and
notes |
*use at your own risk
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