Pediatric surgery. Compression of the intestinal lumen by cystic formations (most important)

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Pediatric surgery. Compression of the intestinal lumen by cystic formations (most important)

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44. Compression of the intestinal lumen by cystic formations

Cysts of the abdominal cavity and retroperitoneal space, as well as cystic doubling of the gastrointestinal tract in some cases narrow the lumen of the intestinal tube and cause a symptom complex of recurrent obstruction.

clinical picture. In cases of compression of the intestinal lumen by a cyst, paroxysmal abdominal pain periodically occurs, the localization of which cannot be identified in young children. Older children complain of pain below the navel. The attacks are accompanied by vomiting and stool retention. When examining a child, asymmetry of the abdomen can be noted due to a protruding tumor-like formation and visible intestinal motility. Superficial careful palpation can sometimes identify a moderately mobile and painful cystic mass in the abdominal cavity. Its presence is confirmed by digital examination through the rectum. Detection of a small mesenteric cyst is almost impossible due to its easy displacement and difficulties associated with the patient’s anxiety.

X-ray examination. X-ray examination in such cases rarely helps to recognize the true cause of the disease.

Differential diagnosis. Complicated cysts must be differentiated from mechanical intestinal obstruction (chronic and acute) caused by other causes. A detailed analysis of anamnestic data (periodic attacks of pain, constipation, vomiting, abdominal enlargement) and clinical symptomatology (presence of a cystic mass in the abdominal cavity, atypical manifestations of supposed intussusception, helminthic obstruction), some radiological findings should be alarming in relation to a complicated mesenteric cyst.

Treatment. Children with complicated mesenteric cysts should be operated upon once the diagnosis is established. The choice of surgical intervention method is determined by the nature of the cyst and the patient’s condition.

postoperative treatment. All children are prescribed antibiotics intramuscularly, vitamins of groups B and C, heart medications (according to indications), oxygen for the first 2-3 days. In order to prevent pneumonia, the child is given an elevated position, physiotherapy, breathing exercises, and frequent turning in bed are carried out. In the presence of vomiting, the stomach is washed 1-2 times a day with a warm 1% soda solution. If the Ledd operation or the separation of adhesions was performed without violating the integrity of the intestine, then the child begins to drink by the end of the 1st day. For the prevention of pain and the fight against intestinal paresis, long-term epidural anesthesia (3-4 days) is indicated. In cases where a bowel resection was performed or a bypass anastomosis was formed, the child is on parenteral nutrition for 2 days. Compensation for the lack of proteins resulting from chronic malnutrition and losses during surgery is of great importance.

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

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