Intestinal Obstruction Flashcards
In which group of population do we commonly see duodenal atresia?
Triosomy 21
What is the common clinical presentation of duodenal atresia?
Billous vomitting without abdominal distension
What is the key radiological feature of duodenal atresia?
Double bubble sign
If you see double bubble sign, and you find gas distally in the rectum, what would be your differential?
Stenosis instead of atresia
What is the non-operative management of duodenal atresia?
NPO, NGT, IVF.
What are the other abnormalities that are commonly seen with duodenal atresia?
Congenital heart defect - kidney - anorectal malformation.
What is the surgery of choice for duodenal atresia?
Duodeno-duodenostomy
Diamond shaped anastomosis
What are the alternatives for duodeno-duodenostomy?
Duodeno-jejunostomy
Side to side duodeno-duodenostomy
Tapering duosenoplasty
Triple bubble in x-ray abdomen appearance indicate the presence of
Jejunoileal atresia
What is the characteristic signs of jujenoileal atresia?
Passage of gray plugs of mucus in the rectum + villous vomitting + jaundice + abdominal distension
Differentiate between bowel distention in duodenal atresia and in meconium ileus
Meconium ileus occur before even swalloing air.
What is a risk factor for jejunoileal atresia?
Polyhydraminos
What are the types of jejunoileal atresia?
1- stenosis 2- type 1 2- type 2 3- type 3a 4- type 3b 5- type 4
Describe the lesion in type 1 jejunoileal atresia?
Bowel is in continuity, but membrane is causing the obstruction
Describe the lesion in type 2 jejunoileal atresia?
Intact mesentry + bowel connected by fibrous band
Describe the lesion in type 3a jejunoileal atresia?
V shape mesentry
What makes type 3b difficult to manage?
Because it’s supplied by one single artery
What could be a complication of treating jejunoileal atresia?
Short bowel syndrome
Where do we see the apple core appearance sign?
In type 3b jejunoileal atresia
Describe the lesion in type 4 jejunoileal atresia?
Sausage like lesion
How does meconium ileus usually present
- distension
- visible loops
- doughy abdomen
- maternal polyhydaminos
When you diagnose meconium ileus in patient, your must test for:
Cystic fibrosis
What is the pathophysiology of meconium ileus?
Dysfunction in exocrine-eccrine function.
Loss production of mucus and meconium clogs the bowel.
In which disease do you expect to see soap bubble appearance?
In meconium ileus
What are the radiological signs to see in meconium ileus?
- thickening
- disparity in the diameter of bowel.
[some dilated some are collapsed] - ground glass\soap bubble appearance
Meconium ileus develops in;
Intrauterine.
What is the role of contrast enema in meconium ileus?
Both diagnostic (can rule out atresia) and theraputic.
What special precautions should be taken in meconium ileus?
- cover w\Ab to prevent translocated bacteria
- hydrate patient
- ensure that there’s an attending surgeon to operate in case of perforations
How do they do the procedure of contrast enema in meconium ileus?
1- insert catheter from rectum then inject enema.
2- inject N-acetylcystine to dissolve meconium
3- place it for 1-3 days in irregate
Treatment in Meconium Ileus in usually:
Non-operative Gastrografin (isotonic water-soluble contrast enema) & 1% N-acetylecysteine
Define Meconium Plug Syndrome
Failure to pass meconium with first 24 hours, Maternal gestational diabetes:
Treatment of Meconium Plug Syndrome:
Non-operative Contrast enema is diagnostic and therapeutic
Non-bilious projectile vomiting and epigastric mass (olive sign):
Hypertrophic Pyloric Stenosis
Hypertrophic Pyloric Stenosis sign in imaging
string sign” or “double railroad track sign”:
hallmark metabolic derangement in Hypertrophic Pyloric Stenosis:
- Hypochloremic
- Hypokalemic
- Metabolic alkalosis
Treatment of Hypertrophic Pyloric Stenosis:
Fredet–Ramstedt pyloromyotomy (without entering the lumen/mucosa)
How does intussecption usually present?
Crampy, sever, intermittent abdominal pain last for 1-2min with 5-10min intervals:
Describe stool in intussecption
Red current jelly stool
Most common site of intussusception:
Ileocecal valve
What is dance’s sign
RLQ mass on plain abdominal film, empty RLQ on palpation
Treatment of intussusception:
Air or barium enema; 85% reduce with hydrostatic pressure
Bilious vomiting in infant considered as a ………. until proven otherwise:
Malrotation ( volvulus )
Procedure done for malrotation (name)
Ladd’s procedure
