Page 17 of 73 INBORN IMPASSABILITY OF INTESTINES
General provisions. Impassability of intestines is observed approximately at 1 of 1500 newborns. Main signs: vomiting, increase in a stomach and absence calla. As the correct diagnosis is usually established only in several days, it is extremely important to estimate timely such symptoms as vomiting and stretching of a stomach. High impassability of intestines is characterized by constants rvotamr1 (even if feeding of the child is stopped); stretchings of a stomach can not be. At low impassability stomach stretching dominates, and vomitings develop later. If the obstruction is localized in a duodenum, then the clinical symptomatology is developed in several hours after the birth, and at colic impassability — in a day or is even later. ATRESIA AND STENOSIS
From the anatomic point of view of the reason, causing inborn impassability of intestines, it is possible to divide on internal (an atresia, a stenosis, mekoniyevy impassability, aganglionarny megacolon) and external (the wrong turn of an intestinal tube, the squeezing tyazh, intra belly hernias p duplikatura). In each case it is necessary to try to define nature of defeat before operation to choose the corresponding surgical tactics.
Full impassability is usually distinguished without effort, but at incomplete impassability there can be considerable diagnostic difficulties. As well as the gullet atresia, high impassability of intestines can be at a hydramnion. In such cases it is necessary to aspirate urgently gastric contents at once after the birth. If 10 — 15 ml of the gastric liquid which is especially painted by bile are aspirated, then it is possible to speak about high impassability with confidence.
Normal release of meconium is characteristic of impassability of upper part of a small bowel.
At duodenal impassability protrusion of epigastric area and peristaltic waves, as are observed at a pyloric stenosis. Protrusion in epigastric area is changeable as it disappears after vomiting. Vomitings, as a rule, rough; emetic masses contains bile if the obstruction is localized below a big duodenal nipple (the most frequent option).
Impassability of the lower part of an ileal gut, thick and a rectum is shown by more extensive stretching of a stomach, especially its lateral areas. Disappearance of hepatic dullness at percussion is a weighty sign to perforation of intestines. At low impassability of vomiting can appear only in a day; emetic masses in that case has a muddy appearance.
At the incomplete impassability of intestines caused, for example, by a stenosis, the squeezing tyazha, duplikatura or incomplete torsion of guts, symptoms (vomitings, increase in a stomach, a lock) develop in one cases right after the birth, in others — in indefinite time. Weight of a condition of the patient also varies — perhaps rapid current, as at full impassability, or rather easy when the disease is diagnosed only at special inspection or an aggravation of process. At incomplete impassability of the indication to the emergency operative measure can arise also often, as well as at full impassability.
Valuable information on the level of impassability of intestines can be obtained at a survey X-ray analysis, without resorting to contrast agents. Full impassability is characterized by intestines stretching above the place of obstruction, existence of levels of liquid and gas in the stretched intestinal loops. At a pnevmoperptoneuma under a diaphragm it is possible to see a strip of free gas. Calcificats in an abdominal cavity indicate development of mekoniyevy peritonitis. At mekoniyevy impassability the symptom of "the ornamented glass" caused by accumulation of vials of gas in a mekoniyevy stopper is observed. Research of a large intestine by means of an opaque enema gives additional information on localization and nature of process, in particular about the shift of a caecum or the wrong turn of intestines. Air in a stomach radiographic is found in the healthy child right after the birth. In 1 h it is observed in proximal department of a small bowel and upper segments of a large intestine, and in 3 — 18 h air reaches distal department of a large intestine.
Forecast. If full impassability of intestines does not manage to be eliminated immediately, then the condition of the patient quickly worsens. Against constant vomiting, dehydration, loss of body weight there occurs the prostration and in several days the child dies. At incomplete impassability of the patient there can live several weeks, and insignificant impassability does not threaten life even without treatment. In many cases both full, and incomplete impassability at early diagnosis and adequate treatment can count on recovery.
Treatment. To the newborn the extensive enterectomy when nature of defeat demands it can be made, but not all types of impassability give in to surgical correction. Have paramount importance preoperative preparation, including aspiration of gastric contents, and postoperative maintaining, especially recovery water-salt" balance, and also parenteral food.
Atresia (full occlusion) and, more rare, a stenosis (partial occlusion) of a digestive tract are the reason of impassability of intestines to Ouse of cases. Sites of impassability are most often localized in an ileal gut (50% of cases), a duodenum (25%), is more rare — in a jejunum, is never absolutely rare — in a large intestine and almost — in a stomach. The increased frequency of an atresia duodenal, and also a rectum is noted at children with a Down syndrome. Approximately in 15%) cases of an atresia of a digestive tract have multiple localization. Morphologically allocate three types of an atresia: 1) the gleam of a gut is as if partitioned by a membrane (diafragmopodobny type); 2) the blind end is not connected with a distal segment; 3) the intestines segments connected by shnurovidny tyazha.