Pediatric surgery. Differential diagnosis and treatment of prepyloric gastric obstruction (most important)

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Pediatric surgery. Differential diagnosis and treatment of prepyloric gastric obstruction (most important)

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35. Differential diagnosis and treatment of prepyloric obstruction of the stomach

Differential diagnosis have to be carried out with diseases that occur in the first days and weeks of life and are accompanied by regurgitation and vomiting that does not contain bile.

Pyloric stenosis. It is most difficult to differentiate this anomaly from prepyloric gastric stenosis if the symptoms of the latter arose from the 2-3rd week of the child’s life. In all cases, it is necessary to perform an X-ray examination with a contrast agent. Often this examination does not definitively establish the cause of gastric obstruction. In such cases, the diagnosis is made based on laparotomy data.

Pylorospasm. Due to the fact that with this pathology, symptoms arise from the first days of a child’s life, it is necessary to differentiate pyloric spasm with atresia or decompensated gastric stenosis. Persistent, numerous vomiting, causing a disturbance in the general condition of the child and leading to a sharp drop in body weight, is not characteristic of pylorospasm. In addition, the effectiveness of antispasmodic drugs indicates the functional nature of the disease.

Congenital obstruction of the duodenum when the obstruction is located above the Vater nipple has a similar clinical and radiological picture. Usually the final diagnosis is made during surgery. In other types of congenital intestinal obstruction, vomit contains bile, which makes it possible to exclude an anomaly in the development of the stomach.

Congenital diaphragmatic hernia of the esophagus in some cases it is manifested by vomiting from the first day of a child's life, but the vomit usually contains bile or blood. In addition, the diagnosis is aided by X-ray contrast examination, in which a diaphragmatic hernia is confirmed by the location of the stomach above the level of the thoracic obstruction.

Treatment. Preoperative preparation for atresias and decompensated stenoses usually does not exceed 24 hours and is aimed at restoring homeostasis and treating aspiration pneumonia. In case of stenosis, preparation for surgery, if necessary, can be extended to several days.

Postoperative treatment is aimed at correcting impaired water-salt metabolism, restoring the functioning of the gastrointestinal tract, preventing and treating aspiration pneumonia.

Within 2-3 days the child is on parenteral nutrition.

If the patient had a probe below the anastomosis site during the operation, then a day later they begin to introduce breast milk (5-10 ml every 3 hours), increasing the amount of the latter by 10 ml per feeding daily. The probe is removed after 4-5 days and oral feeding is started. The child receives antibiotic therapy, blood transfusions, administration of plasma, albumin. In the presence of pneumonia, aerosols are used up to 5-6 times a day, physiotherapy. The stitches are removed on the 10-12th day.

Authors: Drozdov A.A., Drozdova M.V.

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