First one with correct answer with justification win.

 

At day of life one, a 39 week gestational age healthy baby presents with abdominal distention and vomiting after two feeding attempts. The emesis is green tinged. An abdominal radiograph and lower intestinal contrast study are obtained as shown.

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[size=20px]Operative management of this patient with bilious vomiting must include

 

A rectal biopsy.

 

B diverting ostomy.

 

C intestinal resection and primary anastomosis.

 

D appendectomy.

 

E Ladd procedure.[/size]

B

think again my friend

c

think again my friend

A

A

correct

 

Colon atresia occurs in 1 in 20,000 births, representing two to 10% of all intestinal atresias. Hirschsprung disease (HD) may be seen in two percent of patients and, therefore, suction rectal biopsy is indicated prior to primary anastomosis. Nonfixation of the distal colon may predict the presence of concomitant HD in colon atresia but there have also been instances of normal rotation in infants with colon atresia and HD.

 

There are various management options for colonic atresia including primary anastomosis or diverting ostomy. The choice of operation will depend on comorbid conditions and the presence or absence of HD. Historically, some authors used resection and primary anastomosis in right sided colonic lesions and colostomy with future reanastomosis in left sided lesions. When a decision is made to perform a primary anastomosis, it is typically necessary to remove the bulbous colon just proximal to the atresia since the motility and function of this segment may be poor.

A Ladd procedure is performed for malrotation if it is present. An isolated appendectomy is not necessary in this child.