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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-seven patients with gastroschisis were seen at the Red Cross War Memorial Children's Hospital between 1960 and 1977. Twenty-five children were operated on either by primary closure, by skin closure alone, or by the insertion of a reinforced Silastic pouch or patch. The mortality rate has been reduced from 62% to 33% over the past 6 years. Despite better metabolic and respiratory care and intravenous alimentation, serious complications still occur, particularly when prematurity and associated anomalies such as atresia or meconium ileus exist. Other problems were respiratory complications, ileus, perforation, gangrene, intestinal obstruction, enterocolitis and disaccharide intolerance. The long-term follow-up of some of these patients is described.
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PMID:Complications and follow-up of gastroschisis. 15 4

Within a period of 15 years 649 neonates were subjected to laparotomy; 60 (9%) of these patients died. Eighty-seven of the patients had a peritonitis already preoperatively without intestinal obstruction. Many of these were cases of ruptured omphaloceles or gastroschisis. In 17 infants a spontaneous intestinal perforation was the cause of the peritonitis. In 13 there was a preexisting meconium peritonitis. Seven children suffered from gangrenous intestine. Further causes for preoperative peritonitis were a complicated enteritis in 7 and a perforated appendix in 2 cases. Twenty-five or 29% of the children died. The highest mortality was found in children with ruptured omphalocele. It was 50% followed by gastroschisis with 36%. The mortality in patients with spontaneous intestinal perforation was rather similar, and the same high fatality rate was observed in infants with gangrenous intestine. In 28% of the children no cause for the peritonitis could be discovered. The high mortality rate is primarily due to the infants' bad general condition, i.e., low birth weight, prematurity and additional severe malformations.
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PMID:Mortality of preoperative peritonitis in newborn infants without intestinal obstruction. 52 59

Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7). Seventy patients had congenital anomalies (50 single, 20 multiple). Diagnostic evaluations included 56 upper gastrointestinal series and 27 barium enemas. Each patient underwent correction of malrotation and appendectomy, and correction of congenital anomalies (omphalocele-9, gastroschisis-6, diaphragmatic hernia-7). Complications included short gut (2), sepsis (5), feeding difficulties (2), pneumonia (3), small bowel obstruction (2), and other (15). Nine patients (8.8%) died (trisomy 18-1, trisomy 13-1, intestinal necrosis-3, hepatic failure-1, prematurity-1, other sepsis-2). Two hundred sixteen children with intestinal malrotation have been treated from 1937 to 1987. Mortality rate has improved from 23% to 2.9%.
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PMID:Malrotation of the intestine in children. 154 4

Our experience in the management of 138 infants with various causes of intestinal obstruction has provided us with important principles of diagnosis and treatments that we adhere to in the course of our practice. 1. The overall mortality of neonates suffering from intestinal obstruction should be fewer than 5 per cent. The high survival rate is accounted for by improved care these patients receive in specialized units. 2. Prematurity did not appear to play a significant factor in the outcome of these infants with intestinal obstruction. Our experience shows that premature infants tolerate operative procedures well, even in those instances in which an associated surgically correctable lesion is simultaneously repaired. 3. The major risk factor in any neonate with intestinal obstruction is the delay in diagnosis and operative intervention, especially in infants diagnosed to have midgut volvulus. The additional second risk factor is the association of chromosome abnormality. 4. Traditional diagnostic studies such as plain films of the abdomen supplemented by either an upper GI or lower GI contrast study for specific indications have been very effective in obtaining an accurate diagnosis of intestinal bowel obstruction. 5. Hirschsprung's disease can be diagnosed in the neonatal period if the index of suspicion for this is high. 6. Special surgical techniques as described should be used whenever indicated to minimize morbidity. 7. The traditional Wangensteen-Rice evaluation of a patient with imperforate anus is accurate, and specialized studies should be deferred for the postoperative period. Collaborative care provided by the neonatologist, pediatric anesthesiologist, and pediatric surgeon for these patients is the key to a favorable outcome.
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PMID:Neonatal intestinal obstruction. 272 Nov

Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of necrotizing enterocolitis (NEC). Identification of these lesions by the use of routine contrast enemas has been advocated as a means of decreasing potential morbidity from delayed diagnosis. However, the significant incidence of spontaneous resolution and reluctance to submit asymptomatic infants to contrast enema have led recent researchers to reserve these studies for patients developing symptoms of obstruction during a period of close observation. From July 1984 to July 1986, symptomatic strictures developed in five infants (15%) responding to medical management at our institution. Contrast enemas were not routinely performed and four (80%) of these patients presented with life-threatening sepsis or perforation associated with intestinal obstruction. Two infants developed complete colonic obstruction 4 and 6 weeks after discharge from the Intensive Care Nursery, having initially tolerated oral feedings. Both infants were critically ill due to perforation or sepsis and underwent emergency colostomy at community hospitals. Two other infants developed abdominal distension with sepsis and cardiopulmonary decompensation while remaining hospitalized for prematurity and pulmonary insufficiency. These patients became symptomatic 5 and 7 weeks after cautious refeeding while closely monitored in the Intensive Care Nursery. The occurrence of such life-threatening complications suggests that clinical observation alone is not adequate in the management of many of these infants. Contrast enemas should be performed to identify those patients at risk of such potential morbidity or mortality, especially those infants not residing near pediatric surgical facilities.
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PMID:Post-necrotizing enterocolitis strictures presenting with sepsis or perforation: risk of clinical observation. 304 59

Fifty-seven cases of apple peel jejunal atresia have been reported in the English literature. Patients with this anomaly have a high incidence of prematurity (70%), malrotation (54%), short gut syndrome (74%), multiple atresias (15%), complications (63%), and mortality (54%). Mortality has decreased from 63% to 47% since 1970. We report three new cases of apple peel jejunal atresia, including two from one family. Radiographic evidence of high small bowel obstruction and a malrotated microcolon on preoperative roentgenogram with barium enema should suggest this diagnosis. Five families, including ours, have been reported in which more than one child was affected, and it has been suggested that this disorder is transmitted by an autosomal recessive gene. However, the occurrence of conventional intestinal atresia in other siblings, the association with multiple atresias, and discordance in a set of apparently monozygotic twins indicate that there may be a more complex spectrum of genetic transmission. Subsequent siblings are at increased risk for apple peel atresia or related malformations. Prenatal ultrasound can facilitate early diagnosis and treatment.
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PMID:Familial apple peel jejunal atresia: surgical, genetic, and radiographic aspects. 330 63

Spontaneous localized perforation of the gastrointestinal tract, unrelated to mechanical intestinal obstruction and with no evidence of necrotizing entrocolitis (NEC), occurred in 20 neonates. Three perforations were located in the stomach, 11 in the small intestine, and six in the colon. Maternal obstetric complications as well as prematurity and postnatal distress were common in these patients. The overall survival rate was 80%. There was no late gastrointestinal symptoms in the survivors. Whether idiopathic perforation of the gastrointestinal tract results from a localized form of NEC or from a distinct lesion of unknown etiology has not yet been ascertained. Some ideas concerning the etiology of this entity, as well as some diagnostic aspects are discussed.
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PMID:Idiopathic gastrointestinal perforation in the neonate. 338 86

A review of 52 consecutive cases of congenital diaphragmatic hernia composed of 36 cases of Bochdalek hernia (B.H.) 13 of diaphragmatic eventration (D.E.), and 3 of diaphragmatic agenesis (D.A.) is reviewed critically. The operative mortality rate in Bochdalek hernia was 8.3% but became 20% with reference to the 15 infants with B.H. operated in the first 24 hrs. of life and 31.5% with reference to all 19 infants requiring repair of the diaphragmatic defect during the first day after birth. The operative mortality in D.A. was 100% and was nil in D.E. The mortality appeared related directly to prematurity, early age at operation, preoperative hypoxemia (PaO2 less than or equal to 60), hypercarbia, (PaCO2 greater than or equal to 60), and acidosis (pH less than or equal to 7.0), association with life-threatening anomalies affecting the lungs and its vessels, the heart, the size of the diaphragmatic defect and of the celomic cavity, the postoperative development of NEC and of obstructing intestinal adhesions. Eight of the 33 survivors (24%) with B.H. developed intestinal obstruction secondary to adhesions 2 months to 14 years after operation, of whom 7 required surgical intervention, and 3 bowel resections. The total mortality rate in B.H. was 14% and the rate in this series of combined defects was 15%.
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PMID:Congenital diaphragmatic hernia and eventration. 361 33

Although duodenal atresia is a common cause of congenital intestinal obstruction, the optimal technique of repair remains controversial. In a 10-year period, 41 newborns (20 male, 25 premature) underwent either side-to-side duodenoduodenostomy (SDD, 10 infants), side-to-side duodenojejunostomy (SDJ, 9 infants), or diamond-shaped duodenoduodenostomy (DDD, 22 infants) in a nonrandomized series. One-layer anastomosis was used in each case, and gastrostomy was placed in most patients. Groups were compared for survival, prematurity, associated anomalies, time until feeding onset, total hospitalization time, and complications. The three groups were identical for survival (all 100%), prematurity (60% SDD, 67% SDJ, 59% DDD), and serious associated anomalies (cardiac, gastrointestinal, Down's; 33% SDD, 44% SDJ, 50% DDD). The time until feeding onset was shortest with DDD (4.1 +/- 0.4 days), compared with 8.0 +/- 1.1 days for SDD and 9.6 +/- 1.9 days for SDJ (both P less than .05 v DDD). Total hospitalization was significantly less in DDD (16.2 +/- 2.1 days) v 24.2 +/- 3.1 days for SDD (P less than .05) and 28.3 +/- 4.3 days for SDJ (P less than .01). One complication necessitating reoperation occurred in each group (SDD, adhesions; SDJ, stenotic anastomosis; and DDD, missed second atresia). These data suggest that DDD is superior to SDD and SDJ for repair of duodenal atresia, resulting in earlier feeding and discharge.
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PMID:Duodenal atresia: a comparison of techniques of repair. 379 78

A set of xiphopagus conjoined twins with prematurity, exomphalos, and intestinal obstruction was separated successfully. Preoperative evaluation included computerised axial tomography, 99mTc-HIDA scan, and barium enema. Major hepatobiliary and gastrointestinal anomalies were encountered. One twin is alive and well today. The other twin died one week postoperatively from sepsis. Postmortem studies showed she had a severe cardiac anomaly incompatible with normal life.
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PMID:Management of xiphopagus conjoined twins with small bowel obstruction. 394 59


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