Feb 3, 2010

Small Intestinal obstruction



A 4 yrs old child is presented with vomiting & pain in abdomen. Initially, vomiting were whitish/or food taken then later on vomitings became yellowish. The child was having severe pain in abdomen. Abdomen was distended. There was tenderness (pain on palpation) all over abdomen. Bowel peristalsis were sluggish.

X-ray abdomen in standing position revealed multiple air fluid levels. Ultrasonography abdomen shows dilated bowel loops with sluggish peristalsis. Minimal fluid was present in peritoneal cavity.All these investigations typically suggestive of intestinal obstruction.

Child was posted for surgery.On exploration there was small intestinal volvulus with a band crossing & obstructing.The band was nothing but a part of small intestine. Once the volvulus derotated & small intestinal band released, obstruction relieved. Some portion of bowel involved in volvulus was looking bluish & preischaemic. After putting hot mops, giving 100% oxygen, the bowel color changed. After inspecting all intestine and other structures in abdomen, abdomen closed in layers.

The child was kept nil by mouth for 48 hours within this period the bowel sounds returned & child passes gases. Then slowly water, liquids introduced & once child started tolerating soft died the child was discharged.

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