Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Upcoming SlideShare
Meconium ileus case presentation
Next
Download to read offline and view in fullscreen.

17

Share

Download to read offline

Meconium ileus surgical management

Download to read offline

Mangament, Surgical and non Surgical management of meconium ileus

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Meconium ileus surgical management

  1. 1. Review of Surgical options in Simple Meconium Ileus Dr. Almumtin, Ahmed
  2. 2. Introduction • Isolated versus part of an entity. • Simple and Complicated types.
  3. 3. Incidence and pathogenesis • 9-33% of all intestinal obstruction. • 1:25000 newborns. • 3rd case of neonatal small bowel obstruction. • prenatal detection. • association with congenital anomalies
  4. 4. Genuine associations • Cystic fibrosis and meconium ileus. • Meconium ileus and the premature infants. • Meconium with lower carbs, high proteins, and albumin. • CFTR gene, approx 1000 mutations.
  5. 5. Clinically and Gross description • Presentation: • Abd. distension 96% • bilious vomiting 50% • delayed passage of meconium.
  6. 6. Differential Diagnosis
  7. 7. Radiographically • Plain X-rays: • Unevenly dilated loops of bowel • Variable presence of air-fluid levels • Bubbles of gas. • Contrast enema: • Microcolon.
  8. 8. Treatment • Non-Operative. • Operative.
  9. 9. Non-Operative treatment • Volume resuscitation. • Gastric decompression • Respiratory support if needed. • empirical antibiotics. • Hyperosmolar enema washout
  10. 10. Hyperosmolar Enema • Aims for hydration and softening of meconium mass. • Careful resuscitation, hydration, appropriate electrolytes repletion and maintenance of normothermia. • Must be performed under fluoroscopic control. • slow infusion to the rectum. Meconium pellets usually will pass in the next 24-48 hours. • Warm saline enemas with 1% N-acetylcysteine is of help
  11. 11. Hyperosmolar Enema • after successful evacuation, 5 ml of 10% N- acetylcysteine is given through NGT Q6 hours. • Consider pancreatic enzymes if suspecting CF. • Success rate range 63-83%
  12. 12. Operative Management • Indications: • Inadequate meconium evacuation or complications of contrast enema. • failure of hyperosmolar enema to promote passage of meconium in 24-48 hours. • if associated with intestinal atresia
  13. 13. Principles • Manual evacuation. • Entrotomy, intraoperative saline irrigation, mechanical separation of pellets from bowel wall. • 2% or 4% N- acetylcysteine or 50% hyperosmolar solution instillation can be helpful.
  14. 14. Principles • Resection of the extremely dilated proximal segment (in order to avoid size discrepancy) anastomosis. • Complication is leak. • The other option; resection, with creation of stoma.
  15. 15. Techniques • Mikulicz Double barrel enterostomy. • Advantages: • Less operative time. • Risk of leak is avoided. • Solubilizing agents can then be administered in distal and proximal loops. • Disadvantages: • Potential high stoma output and fluid losses. • long resections can result in short bowel • the need for another surgery to restore continuity in later time.
  16. 16. Techniques • Distal chimney enterostomy (Bishop- Koop procedure ) • resection with anastomosis between the end of the proximal segment and the side of the distal segment of bowel approximately 4 cm from the opening of the distal segment • The distal end is brought out as the ileostomy • This technique allows for normal gastrointestinal transit while providing a means for management of the distal obstruction through the ileostomy should it occur
  17. 17. Techniques • Proximal chimney enterostomy (Santulli) • Distal limb end is anastomosed to the side of proximal limb • enhanced proximal irrigation and decompression. • no need for evacuation at the time of surgery • risk of high output stoma, and consequent electrolyte disturbance and dehydration.
  18. 18. Techniques • Primary resection and anastomosis • resection of the obstructed segment. • irrigation of remaining pellets in the distal bowel. • ileocolic anastomosis. • disadvantages: • Anastomosis complications. • resection of additional bowel (terminal ilium containing pellets with the dilated segment of ileum)
  19. 19. Post-operative management • Resuscitation, maintenance fluids. • Replacement of fluid losses ( through NGT or ileostomy) • 2 or 4% N-acetylcystein via NGT or ileostomy. • Workup of Cystic fibrosis. • Keeping the placed stoma in mind for future closure.
  20. 20. Nutrition Support • As bowel function resumes, oral feeding can start with breast milk or infant formula. • Supplemental pancreatic enzymes and vitamin. • those with long post-surgical course might require enteral feeds or TPN. • watch for TPN associated cholestasis. • Glutamine-enriched formulas to the distal bowel maybe tried to enhance bowel growth
  21. 21. References • Pediatric Surgery Diagnosis and Management, Prem Puri, Michael Holwarth • Ashcraft’s pediatric surgery, 5th edition. • Pediatric Surgery (Springer Surgery Atlas Series). • Operative pediatric suregry, Lewis Spitz, Arnold G Coran. 7th edition
  22. 22. Thank You
  • ZuberiBeyan

    Mar. 9, 2021
  • faizankhaliq1

    Jan. 13, 2021
  • MacksonNongmaithem

    Oct. 28, 2020
  • FahimFerdous2

    Oct. 1, 2020
  • AparnaChoudhury6

    Sep. 8, 2020
  • yosdulu

    Jun. 5, 2020
  • MasudRana349

    Mar. 6, 2020
  • KovidhaKolupuri

    Nov. 22, 2019
  • gavfalk

    Sep. 28, 2019
  • MohammedDuraid1

    Apr. 19, 2019
  • MazharGhari

    Jan. 21, 2019
  • DebalinaKarmakar

    Sep. 17, 2018
  • NoppawanMai

    Aug. 31, 2018
  • AbhishekThakur230

    May. 6, 2018
  • YasminMuhammad2

    Mar. 23, 2018
  • mmcnidhi

    Sep. 17, 2017
  • GopakumarGovindapillai

    Jul. 12, 2017

Mangament, Surgical and non Surgical management of meconium ileus

Views

Total views

6,460

On Slideshare

0

From embeds

0

Number of embeds

17

Actions

Downloads

217

Shares

0

Comments

0

Likes

17

×