Enterectomy(resection For Congenital Atresia)

ENTERECTOMY (RESECTION FOR CONGENITAL ATRESIA) REASON FOR VISIT: Bilious emesis Abdominal distention (in distal atresias) Jaundice (32%) Failure to pass meconium in the first 24 hours Dehydration, manifested by sunken fontanel and dry membranes Decreased urine output (best clinical indication of tissue perfusion) Tachycardia Decreased pulse pressure Low-grade fever Neurological involvement, manifested by irritability, lethargy, or coma Failure to tolerate feedings Nausea and Vomiting Bilious vomiting Intermittent, abdominal pain

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RISK ASSESSMENT • • • • • • •

Family history of bleeding disorders Unstable cardiovascular system Liable heat control Low birth weight History of bleeding disorders History of allergy to medications History of allergy to anesthesia

PREPARATION OF THE PATIENT: • • • • • •

Blood tests Urine tests Plain abdominal radiography of the kidneys, ureters, and bladder (KUB) Upper GI series Barium enema study Abdominal X-ray Ultrasonography

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Preoperative antibiotics were administered to the patients with diseases of the heart valves Oral feeding was stopped for ____hrs before procedure Electrolyte imbalance, fluid imbalance, acid/base imbalance was corrected by using the intravenous infusion An orogastric tube was placed for gastric decompression and to avoid aspiration Frequent nasopharyngeal aspiration was done to keep airway clear Part was prepared and draped in sterile fashion

ANESTHESIA: General anesthesia POSITION OF THE PATIENT Supine position THE PROCEDURE OPEN LAPARATOMY • • • • • • • • • • • •

The abdomen was entered through a supraumbilical transverse incision The entire intestine was delivered through the incision Type of atresia is noted and to other anomalies were rule out The duodenal atresia/ jejunoileal atresia was present Perforation was present Perforation was controlled Further exploration was done. Normal sodium chloride solution into the distal pouch and to milk it caudally was irrigated The intestine was returned to the abdominal cavity keeping the atretic segment exposed. The intestinal length is normal/ reduced The dilated proximal pouch was resected, by removing 10-15 cm of dilated bowel proximal to the atresia Instillation of normal sodium chloride solution with a 24-gauge needle through a pursestring suture into a clamped distal pouch was done to distend that segment and to reduce the size discrepancy between the proximal and distal intestine

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The proximal intestine was transected at a right angle to maximize its vascularity, The distal bowel was transected obliquely and the incision was continued along the antimesenteric border as a fish mouth to equalize the size of the openings on both sides for the anastomosis 1- or 2-layer, end-to-back (end-to-oblique) anastomosis was performed. The mesenteric gap was approximated with fine absorbable sutures by taking care to avoid kinking the anastomosis and damaging the mesenteric vessels. Patency of the anastomosis can be tested by milking intestinal air through it. The intestinal segment was moistened with warm normal sodium chloride solution and returned to the abdominal cavity. The abdominal wall was closed in layers with absorbable sutures.

The removed portion of the bowel is sent to the histological /pathological examination

FINDINGS: •

Atresia is found in___________ segments.

AFTER PROCEDURE • • • • • • • •

Transferred to the neonatal ICU Thermoregulation was done with an incubator. Oxygen saturation monitored, Maintenance fluids were administered. The gastric output was closely monitored and replaced volume for volume. Transfusion was administered Glucose, hemoglobin, electrolytes, and Bilirubin levels are frequently monitored Phototherapy was done

DURATION _______hrs.

POSTOPERATIVE CARE • •

Take antibiotic treatment as prescribed Take pain medications as prescribed

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Observe for any discharge from suture site Surgical wound dressings will be kept clean and dry Start feeding after _____hrs /days Give Vitamin B supplements

COMPLICATIONS • • • • • • • • •

Infection Pneumonia Peritonitis Sepsis Anastomotic leaks Functional obstruction at the level of the anastomosis Short-bowel syndrome Malabsorption Steatorrhea

FOLLOW UP After ______ days