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Pediatric Surgery (Pg 68-81) - page 3 / 33

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b)

Presentation:

(1)

EA: immediate chocking & regurg w/ feeding, excess drooling, can’t pass NG tube, Air in abd if w/ TEF (not if isolated EA)

(2)

TEF (isolated): “H” type worst (get aspiration pneumonia), Dx w/ endoscopy or contrast swallow

c)

Tx (good Px): Elevate head, double-lumen tube in upper pouch to suction, primary repair if possible, staged repair + gastrotomy if needed

D.

Congenital GI obstruction – anywhere from stomach to anus (Tables 2-8, 2-9)

1.

Presentation: Varies according to site of obstruction

2.

Key signs: Polyhydramnios, Bilious vomiting, Abd distension, &Failure to pass meconium

3.

Dx w/ Plain x-rays:

a)

Complete Prox: Few dilated bowel loops, air fluid levels, no distal air

b)

Partial prox: do upper GI contrast study

c)

Distal: many distended bowel loops, do contrast enema to verify

4.

Tx: Always includes NG tube, IV hydration, prophylactic Abc’s

a)

Duodenal: Commonly causes by atresia & malrotation

(1)

Atresia often assoc. w/ Down’s syndrome or anular pancreas

(2)

Malrotation w/ Midgut volvulus most common in first month of life = most dangerous form of intestinal obstruction

(3)

Malrotation w/ Ladd’s bands: peritoneal attachments to lateral wall cross over duodenum

(4)

Get “Double Bubble” on x-ray

(5)

Tx: immediate sgx unless midgut atresia is r/o

b)

Small intestine: due to atresia, meconium ileus, intestinal duplication

(1)

X-rays: foamy appearing dilated meconium-filled bowel loops & no fluid air levels; calcification on abd x-ray = antenatal perf

(2)

Duplications = endothelial-lined cystic/tubular structures adjacent to alimentary tract on mesenteric side of nl bowel

(3)

Tx: Atresia & duplications - resection & primary anastamosis Meconium ileus – often nonoperative tx w/ Gastrographin (diatrizoate) enemas (radiopaque fluid)… if persists or if perf present, need sgx

c)

Colon: Hirschprung’s, meconium plug, neonatal small L colon syndrome, atresia (rare)

(1)

W/ Hirschprung’s rectosigmoid colon is most common site for boundry btw aganglionic colon & dilated nl colon; can present immediately or later in childhood

(2)

Dx w/ contrast enema, anorectal manometry, & rectal bx

(3)

Tx is usually staged: Temporary colostomy, then pull-trhough to anastomose proximal (ganglionic) bowel w/ anal canal

(4)

Probs: severe entercolitis w/ dehydration, peritonitis, & sepsis

(5)

Meconium plug (in premature babies) & small L colon syndrome (baby of DM moms) – contrast enema both Dx & Tx

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