Pediatric surgery. Circular intestinal stenosis (most important)

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Pediatric surgery. Circular intestinal stenosis (most important)

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41. Circular stenoses of the intestine

clinical picture. The clinical picture depends on the degree of narrowing and its location. The first signs of obstruction with significant narrowing of the lumen of the small intestine are observed in early infancy. The child experiences periodic attacks of anxiety, bloating, and vomiting. Stools are rare, but independent, gases pass away. The attacks are short-lived, occurring several times a day, sometimes much less frequently. The baby does not latch on well and gains little weight. Gradually, attacks of pain become more intense, stool retention appears, the general condition worsens, and the child is sent to a surgical hospital with a diagnosis of intestinal obstruction.

When examining a patient, attention is drawn to bloating and some asymmetry of the abdomen. Visible peristalsis is usually determined. Intestinal noises are heard, percussion - tympanitis. The abdomen is slightly painful, muscle tension is not detected. On digital examination of the rectum, the ampoule is empty, there may be a small amount of feces. There is no chair, gases do not depart. After an enema, a temporary improvement may occur, gases can pass.

X-ray examination helps in making a diagnosis. Plain radiographs show many horizontal levels in the upper abdomen and gas-distended loops of the small intestine. A study with a contrast agent is possible only in the "light" interval. Given through the mouth, a liquid suspension of barium sulphate in a serial study (every 2 hours) can be detected due to a long delay above the site of narrowing.

The presence of stenosis of the colon appears at an older age, usually after a year. Initially, parents note frequent stool retention, the presence of vomiting, loss of appetite, an increase in the abdomen, and a lag in physical development.

Less pronounced stenoses for a long time may be accompanied by very poor symptomatology: constipation, mild pain attacks, decreased appetite. With age, the compensatory possibilities of the hypertrophied wall above the located intestine weaken, and the clinical picture becomes more definite. Attacks of pain intensify, repeat more often, usually combined with a long delay in stool. Gradually the stomach increases, there is vomiting. Chronic intoxication, hypochromic anemia develops. On palpation of the abdomen, the large intestine is distended with feces.

X-ray examination. Diagnosis is aided by X-ray examination with a contrast mass, which shows prestenotic dilatation and normal distal parts of the colon. In some cases, it is possible to contour the narrowing site.

Treatment. During the period of relapse of obstruction, emergency surgery is indicated. Surgery is performed under endotracheal anesthesia and blood transfusion, and a midline laparotomy is performed.

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

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