Pediatric surgery. Low congenital intestinal obstruction (most important)

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Pediatric surgery. Low congenital intestinal obstruction (most important)

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39. Low congenital intestinal obstruction

One of the main symptoms of low intestinal obstruction is absence of meconium. After the insertion of a gas tube or an enema, the newborn produces only lumps of colorless mucus.

Vomiting appears relatively late, by the end of the 2nd - on the 3rd day of life, and is usually not associated with food intake. The amount of vomit varies (vomiting is often profuse, sometimes resembling regurgitation), but there is always bile staining. Soon the vomiting takes on a meconium character and acquires an unpleasant odor.

The behavior of the child in the first hours after birth does not give grounds to suspect a pathology, but motor restlessness appears very soon. The general condition deteriorates rapidly, intoxication phenomena increase, the child becomes lethargic, adynamic, the skin takes on a gray-earthy color, there may be an increased body temperature (37,5-38 ° C).

On examination, even on the first day, a uniform bloating is detected, which progresses rapidly. The size of the abdomen after vomiting does not decrease. Through the anterior abdominal wall, intestinal loops stretched by meconium and gas are contoured. Their peristalsis is often visible, which is not traced in the later periods, since intestinal paresis occurs. Percussion determined tympanitis in all parts of the abdomen. Auscultation revealed rare deaf noises of intestinal peristalsis. Palpation of the abdomen is painful, accompanied by anxiety and the cry of the child.

With meconium obstruction, sometimes (on the first day after birth) it is possible to palpate a sausage-shaped mobile tumor corresponding to the terminal ileum stretched by meconium.

Atresia of the ileum, as well as the colon, can be complicated by meconium peritonitis, which occurs due to perforation of the overstretched blind end of the intestine. The general condition of the child at the same time deteriorates sharply, vomiting becomes continuous, body temperature rises. The anterior abdominal wall becomes pasty, a network of dilated venous vessels is visible.

X-ray examination. X-ray examination begins with overview photographs of the abdominal cavity. Radiographs show distended loops of intestine with multiple uneven horizontal levels (obstruction of the distal ileum and colon) or several large gas bubbles with wide levels (obstruction of the jejunum or ileum, meconium ileus). If low intestinal obstruction is suspected, a study is performed with a water-soluble contrast agent injected into the rectum with a syringe through a catheter. With low obstruction, radiographs show a sharply narrowed colon filled with a contrast agent. Perforation of the dilated section of the intestine above the site of obstruction is usually detected radiographically by the presence of free gas in the abdominal cavity.

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

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