Pediatric surgery. High congenital intestinal obstruction (most important)

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Pediatric surgery. High congenital intestinal obstruction (most important)

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38. High congenital intestinal obstruction

The clinical picture of high congenital obstruction appears, as a rule, from the first day of life, and sometimes in the first hours after birth. The most constant and early symptom is vomiting. With obstruction of the duodenum above p. Vateri vomiting occurs soon after birth, the amount of vomit is plentiful, there is no admixture of bile in their composition, which enters the intestine entirely. With obstruction of the duodenum below p. Vateri, and also in the presence of an obstruction in the initial section of the jejunum, the vomit is stained with bile. After the newborn is attached to the mother's breast, vomiting becomes repeated and profuse, exceeding the amount of milk taken by the child. The frequency of vomiting and the amount of vomit vary somewhat depending on the type of obstruction. With atresia, it is more frequent, continuous, striking in its abundance. In the vomit, there is sometimes an admixture of blood. With partially compensated stenoses, vomiting occurs on the 2nd-4th day of the child's life and usually not immediately after feeding, but after 20-40 minutes.

Children with high congenital obstruction usually have meconium. If the obstruction is located above p. Vateri, the amount and color of the meconium is almost normal, and its discharge is observed until the 3-4th day. With lower obstruction, the amount of meconium is small, the consistency is more viscous than in a healthy child, and the color is grayish.

The behavior of a child with congenital high intestinal obstruction is normal on the first day, but later lethargy may appear. At first, the newborn actively sucks, but as the general condition worsens, he refuses to breastfeed. Characteristic is the progressive loss of body weight (0,2-0,25 kg per day). Already from the 2nd day the dehydration phenomena are clearly expressed.

The abdomen is swollen in the upper sections (especially in the epigastric region) due to the distended stomach and duodenum. In the first days, you can see the waves of peristalsis. After profuse vomiting, swelling in the epigastric region decreases, sometimes completely disappears. There is some retraction of the lower abdomen.

X-ray examination. The examination of the newborn begins with a survey radiography of the abdominal cavity in the anteroposterior and lateral projections with the child in an upright position. With high obstruction, radiological symptoms are quite characteristic. On the anteroposterior images, two gas bubbles with horizontal levels of liquid are visible, which corresponds to a distended stomach and duodenum; on the lateral images, there are also two horizontal levels located at different heights. The size of gas bubbles varies. With a complete interruption of patency in the underlying sections of the intestine, gas is not detected. In rare cases, with partially compensated stenoses and congenital volvulus, single small bubbles of gas can be seen in the intestine.

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

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