Planned Second look laparotomy in neonatal volvulus: A safe approach for bowel salvage
| Autor: | Muna Ahmed Al Shehhi, Laila Obaid Obaid, Mishail Ziaullah, Mokhatar Ali Hassan, Iftikhar Ahmad Jan |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Exploratory laparotomy medicine.medical_treatment Neonatal Volvulus Case Report Ileum Bowel ischemia 030218 nuclear medicine & medical imaging Jejunum 03 medical and health sciences 0302 clinical medicine Laparotomy Medicine Gangrene 030219 obstetrics & reproductive medicine business.industry digestive oral and skin physiology General Medicine Bowel resection Abdominal distension medicine.disease Surgery Volvulus medicine.anatomical_structure Second look medicine.symptom business |
| Zdroj: | Pakistan Journal of Medical Sciences |
| ISSN: | 1681-715X |
| Popis: | Midgut volvulus can result in gangrene and loss of large segments of intestine. After correction of volvulus the viability of intestine may improve and if given sufficient time a large portion of intestine may be saved. A planned second look laparotomy in babies with volvulus and doubtful gut viability can be helpful in saving large bowel segment. We present a case of a newborn baby admitted with bilious vomiting, abdominal distension and melena. An urgent exploratory laparotomy showed midgut volvulus with near gangrene of about 35 cm of proximal jejunum and bluish discoloration of the rest of the small bowel. After de-rotation and warm packs, the vascularity of ileum & distal jejunum returned to normal, however the proximal jejunum remained dusky and bruised. Ladd’s procedure was done and a decision was made to close the abdomen with a plan for a 2nd look laparotomy after 24 hours. A relook laparotomy performed after 24 hours showed, a well vascularized small bowel. No bowel resection was required and abdomen was closed. The baby improved and was discharged in stable condition with no long-term ischemic complications. This case indicates that a second look laparotomy may provide time for revascularization of the intestine with doubtful vascularity and avoid unnecessary bowel resection. |
| Databáze: | OpenAIRE |
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