Neonatal intestinal obstruction

[size=6]A one-day old, 36-week gestation infant is admitted to the neonatal intensive care unit (NICU) with bilious vomiting and abdominal distention. On exam, the infant is fussy but in no acute distress and the abdomen is soft but distended. Abdominal films suggest a proximal jejunal obstruction consistent with a jejunal atresia. At laparotomy, a proximal jejunal atresia with significant dilation is found. Distally there is loss of small bowel consistent with an in utero volvulus and a string of sausage (i.e. type IV) segments of atretic small bowel with each of five segments of bowel measuring between three and eight cm in length. There is a three cm segment of termina…

[size=6]You receive a call from a referring neonatologist regarding a full term newborn with bilious emesis and an abnormal abdominal radiograph. She would like advice about doing further diagnostic studies at her institution. You suggest immediate transfer as the incidence of surgical pathology in term neonates transferred for bilious vomiting is approximately a 26 to 50%. b 51 to 75%. c greater than 75%. d zero to 25%.[/size]

[size=20px]A 25-week gestation premature infant is nine days old and weighs 750 g. She has progressive distention. Radiographs show multiple dilated loops of bowel. Her mother received magnesium sulfate for preterm labor. The next best step in management of this premie with distension is A abdominal ultrasound. B water soluble contrast enema. C suction rectal biopsy. D sweat chloride test. E upper gastrointestinal contrast study.[/size] First one with correct answer with justification win.

[size=20px]The films below are of two term neonates with bilious emesis. Both babies are hemodynamically stable, have soft non-tender, non-distended abdomens, and normal blood gases. Which baby requires immediate further investigation and possible intervention? 1 or 2 ? Why?[/size]

During laparotomy for a 2-day old term male neonate with bowel obstruction and the radiographic images shown, you encounter a very dilated proximal jejunum with the entire distal bowel impacted with small meconium pellets (shown). How would you manage this? How often does a meconium obstruction extend to the proximal jejunum?!

[size=20px]A term baby girl presents on the 2nd day of life with abdominal distention and bilious emesis. No meconium has passed. On examination, the abdomen is distended, but soft and not-tender. There is no mass. A patent anus is found in a normal position. Digital exam encounters resistance above the anal canal. Insertion of a 6-mm Hegar dilator is followed by meconium passage. Plain film and contrast enema are shown. What would you do next?[/size]

A 3-day old baby boy born at 28 weeks gestation develops mild abdominal distention.He already passed several normal meconiums. He has no signs of necrotizing enterocolitis on physical examination or laboratory tests. His abdomen is slightly distended, but soft and non-tender. Abdominal films taken 24 hours apart show a single fixed loop. A water-soluble contrast enema shows a normal colon. Films at the end of the study show persistence of the distended loop. All shown in the images below. How would you treat this patient?

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[center][/center] Any one want a high quality PDF of this chart, post in this thread and use a personalized picture as an avatar, I will send it to you in a private message Edit: available without restrictions

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