First one with correct answer with justification win.

 

You are consulted on a two-day old full term infant with abdominal distention and the following contrast enema is obtained.

 

 

 

 

[size=20px]A moderate amount of meconium passes but distention persists.

 

The most appropriate next step in this infant with distension is

 

A observation.

 

B repeat contrast enema.

 

C laparotomy for enterotomy and irrigation.

 

D laparotomy for ostomy creation.

 

E laparotomy for bowel resection with enteroenterostomy.[/size]

D is correct, stoma formation and colonic biopsy

Think again my friend

A

Think again my friend

B

B

 

correct

 

This patient has uncomplicated meconium ileus and the best next step is to repeat a contrast enema if the first enema does not relieve the obstruction. While there are no exact rules as to the number of attempts that should be made before surgery is indicated, it is generally accepted that in clinical scenarios where the infant is stable, the radiologist is experienced and serial progress is being made, multiple attempts are reasonable. If no progress (i.e. return of significant amount of meconium per rectum or proximal progression of the column of contrast material) is made at all after the first two or three attempts , successful nonoperative treatment is not likely and the risk of perforation on subsequent attempts is increased. If, on the other hand, progress is demonstrated, the efforts can be repeated.

 

Complex, or complicated meconium ileus is defined as meconium ileus associated with meconium pseudocyst, intestinal atresia, volvulus or perforation. In these situations, attempts at medical management are omitted or abandoned in favor of more urgent surgical exploration.