correct answer will be submitted after 48 hrs, please submit answer + justification

 

A term baby is born with abdominal distension and bilious vomiting. Abdominal X-rays reveal dilated loops of bowel without air fluid levels, and a water-soluble contrast enema demonstrates a microcolon without contrast reflux into the terminal ileum. A laparotomy is performed on this stable baby with findings as shown. The bowel is in continuity; however, there is an obvious calibre change in the mid ileum, which is associated with viscid, doughy intraluminal content.

 

 

[size=20px]The most appropriate next step in management is:

 

A Seromuscular biopsies for ganglion cells

 

B End ileostomy above caliber transition

 

C Enterotomy with meconium evacuation facilitated by 20% N-acetylcysteine (Mucomist) irrigation, with Bishop-Koop ileostomy

 

D Enterotomy with meconium evacuation facilitated by 5% N-acetylcysteine (Mucomist) irrigation with enterotomy closure

 

E Loop ileostomy below caliber transition[/size]

Edited September 27, 20206 yr by Admin

D

E

D

C

I think in this scenario, where there is a caliber different and microclon is reasonable to do a B-K ileostomy to ensure well evacuation of meconium and allow the bowel to rest and match in caliber

D

D

Option C

Correct answer

 

D Enterotomy with meconium evacuation facilitated by 5% N-acetylcysteine (Mucomist) irrigation with enterotomy closure

 

This is a case of simple Meconium ileus, underwent operative intervention after failed medical treatment. in most cases, enterotomy with meconium evaluation and then enterotomy closure is sufficient without the need of complex stomas creation