Definition
Reestablishment of intestinal patency in nay number of conditions that create a blockage of the intestinal tract.
Discussion
- Intestinal obstruction is the most frequent gastrointestinal emergency requiring immediate surgical intervention in the newborn.
- Symptoms may include emesis, abdominal distention, and failure to pass flatus and meconium.
- The repair of an intestinal obstruction may include:
-
- Untwisting of a volvulus.
- Division of intestinal band.
- Release of an internal hernia.
- Resection of bowel with anastomosis.
- Creation of an intestinal stoma.
- Surgical intervention should be performed within the first few hour of life, since delay may severely increase the risk of major complications.
Positioning
- Supine, with arms restrained at the side.
Packs/ Drapes
- Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.
Instrumentation
- Pediatric laparotomy tray
- Hemoclip
Supplies/ Equipment
- Thermal blanket with control unit
- Thermal sheets, head covering
- Basin set
- Handheld cautery
- Blades
- Needle counter
- Dissector sponges
- Solutions
- Sutures
Procedure
- The abdomen is open through an appropriate incision related to the anatomic area that is obstructed.
- With atresia or stenosis, the entire bowel is examined to rule out multiple areas of involvement.
- For duodenal artresia, a paramedian or transverse incision is made in the upper abdomen.
- Bypass of the obstructed duodenal segment is usually preferred over resection.
- An antecolic duodenojejunostomy is usually the procedure of choice, in which a loop of the proximal jejunum is brought anterior to the transverse colon and to the side of the distended proximal duodenum.
- A side to side anastomosis is fashioned in one or two layers according to the surgeons preference and size of the small jejunal lumen.
- The abdomen is closed in a routine fashion.
Perioperative Nursing Considerations
- Separate all instruments associated with the anastomosis and follow bowel technique protocol.
- Check all equipment to promote safety and avoid prolonging anesthesia.
- Patient needs to be prepared physically and mentally.
- Circulator should confirm the operative side with the patient.
image by : nlm.nih.gov
