Aug 29, 2006


Intussucception occurs when one part of bowel invaginates (intussusceptum) into an adjacent section (intussuscipiens) which results in intestinal obstruction and venous compression. If uncorrected it can result in arterial insufficiency and necrosis. It is the commonest abdominal emergency between 3 months and 2 years . Peak incidence is between 6 and 9 months. Most cases are idiopathic with the lead point due to enlarged Peyer's patches, Usually due to a viral infection.5% are due to polyp, Meckel's diverticulum, duplication cyst or tumour .Commonest site involved is the ileocaecal junction.

Clinical features are Intermittent colicky abdominal pain and vomiting, Each episode classically last 1-2 min and recurs every 15-20 min, there is Passage of blood - 'red currant jelly' per rectum. Per abdomen a Sausage shaped abdominal mass is felt in upper abdomen. Diagnosis confirmed with water soluble contrast enema or ultrasound.

Treatment is Resuscitation with intravenous fluids and nasogastric tube. Attempt reduction with air or contrast enema under radiological guidance. If peritonitis, shock or failed reduction requires surgery , If bowel necrosis require resection with primary anastomosis

Aug 28, 2006

Duodenal Atresia

Duodenal atresia is a condition in which the duodenum (the first part of the small bowel) has not developed properly. It is not open and cannot allow the passage of stomach contents. The cause of duodenal atresia is unknown, but it is thought to result from problems during the developmental stage in which the embryo's duodenum normally changes from solid to tube-like (recanalization).

Duodenal atresia is present in more than 1 in 3400 live births. Approximately 20-30% of infants with duodenal atresia have Downs syndrome. Duodenal atresia is often associated with other congenital abnormalities.

Symptoms are upper abdominal disension & bilious vomitings which is Continuous even when infant has not been fed for several hours in neonates.This condition may be suggested by fetal ultrasound showing polyhydramnios (excessive amounts of amniotic fluid in the uterus) or distension of the stomach and part of the duodenum.A plain abdominal x-ray may show air in the stomach and first part of duodenum, with no air beyond that classically called as double – bubble sign. An abdominal x-ray with contrast may be helpful

Treatment involves nasogastric tube for gastric decompression, correction of fluid and electrolyte abnormalities and surgical correction with either a duodenoduodenostomy or duodenojejunostomy


What is Malrotation? Malrotation is a type of mechanical obstruction caused by abnormal development of the intestines while a fetus is in the mother's womb. The small and large intestines are the longest part of the digestive system.If stretched out to their full length, they would measure more than 20 feet long by adulthood,but because they are coiled up, they fit into the relatively small space of abdominal cavity. Malrotaion occurs when the intestines don't "coil" properly during fetal development.Malrotation in itself may not cause any problems. However it may be accompanied by additional complications:

1] Bands of tissue called Ladd bands may form, obstructing the first part of the small intestine (the duodenum). 2] After birth, volvulus may occur. This is when the intestine twists on itself, causing a lack of blood flow to the tissue and leading to tissue death. Malrotation is often diagnosed when volvulus occurs, frequently during the first weeks of life.
Obstruction caused by volvulus or Ladd bands are both life-threatening problems. The intestines can stop functioning and intestinal tissue can die from lack of blood supply if an obstruction isn't recognized and treated. Surgery to correct bowel obstruction from malrotation is always necessary and is often performed as an emergency procedure to prevent irreversible, life-threatening injury to the bowel. During surgery, which is called a Ladd procedure, the intestine is straightened out, the Ladd bands are divided, the small intestine is coiled on the right side of the abdomen, and the colon is placed on the left side.

Pyloric Stenosis

Pyloric stenosis is a narrowing of the pylorus, the lower part of the stomach through which food and other stomach contents pass to enter the small intestine. Pyloric stenosis is fairly common - it affects about three out of 1,000 babies. Most infants who develop pyloric stenosis are usually between 2 weeks and 2 months of age - symptoms usually appear during or after the third week of life. It is believed that babies who develop the condition are not born with pyloric stenosis, but that the progressive thickening of the pylorus occurs after birth. An affected infant begins showing symptoms when the pylorus is so thickened that the stomach can no longer empty properly. The first symptom of pyloric stenosis is usually vomiting. Projectile vomiting, in which the breast milk or formula is ejected forcefully from the mouth, in an arc, sometimes over a distance of several feet. Projectile vomiting usually takes place soon after the end of a feeding. The vomit will not contain bile. Babies with pyloric stenosis usually have fewer, smaller stools because little or no food is reaching the intestines. Most babies with pyloric stenosis will fail to gain weight or will lose weight. As the condition worsens, they are at risk for developing fluid and salt abnormalities and becoming dehydrated. After feeds, increased stomach contractions may make noticeable ripples, or visible peristalsis, which move from left to right over the infant's belly. During the exam, there is a pyloric mass - a firm, movable lump that feels like an olive on the right side of abdomen.

USG of abdomen is the diagnostic modality, but sometimes the barium studies of upper tract is done which shows narrowing at pylorus & Delayed passage of barium through thickened pyloric channel. The enlarged, thickened & elongated pylorus can be seen on ultrasound images.

A surgical procedure called pyloromyotomy, which involves cutting through the thickened muscles of the pylorus, is performed to relieve the obstruction from pyloric stenosis. The pylorus is examined through a very small incision, and the muscles that are overgrown and thickened are spread to relieve the obstruction.