[size=20px]A 14-year-old girl with a history of multiple abdominal operations presents with nausea, vomiting, abdominal pain, distention and obstipation. She is hemodynamically stable and has received intravenous fluids. A nasogastric tube has been placed. Her abdominal x-ray demonstrates dilated loops of small bowel. The best next step in management is:

 

A admission for serial abdominal exams and imaging

 

B laparotomy

 

C laparoscopic exploration

 

D contrast challenge via the NG tube

 

E contrast enema​[/size]

A

C, the best

I think need to go for laparoscopic explanation because it's had multiple operations.

Possible of adhesive or internal hernia

Edited November 26, 20232 yr by Drobadamaher

A

If not tender abdomem, which was not mentioned in the scenario,

will try NG contrast(gastrograffin) adhesiolysis

D

the options are quite tricky...I would manage this patient non operatively with suck and drip..and if i need to intervene if obstruction is not relieved after 48hours,ill attempt C ..laparoscopy which might be difficult ...so eventually might need a laparotomy to do the adhesiolysis

Option A

A

Conservative management with drip and suck and serial examinations and x-rays

B complete obstruction need to laparotomy

laparoscopy may be dangerous because previous multiple operations

A

A

correct answer

D contrast challenge via the NG tube

 

Several retrospective studies have demonstrated that a water-soluble contrast challenge is safe and effective in the non-operative management of children with adhesive small bowel obstructions and can be successful in reducing operative intervention. Abdominal exploration would be indicated if there was peritonitis, pneumoperitoneum or failed non-operative management. A contrast enema would not likely be helpful.

 

 

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