Download MBBS Pediatric Surgery Presentations 3 Short Gut And Intestinal Failure In Pediatric Surgery Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pediatric Surgery 3 Short Gut And Intestinal Failure In Pediatric Surgery PPT-Powerpoint Presentations and lecture notes

SHORT GUT AND INTESTINAL

FAILURE IN PEDIATRIC SURGERY

SHORT BOWEL SYNDROME

The decreased absorptive

ability of intestines- either

due to short length or

functional reduction due to

diseases- jeopardizing

survival.

Due to:
1. Congenital gut defects
2. Malabsorptive diseases
3. Surgical removal of long

segments of intestines


Normal bowel length
Neonatal: 200-300 cm
Children:


Adult : 700-800 cm

SHORT BOWEL SYNDROME

Various definitions:

1. 50% or more of the small bowel resected.
2. When Ileocaecal valve is present: 25-30 cm
When ileocaecal valve is absent: 40cm

If Ileocaecal valve is lost,

transit time is faster and loss
of fluid and nutrients is greater.




ETIOLOGY

Necrotising enterocolitis (35%)

Intestinal atresias (25%)

Gastroschisis (18%)

Malrotation with midgut
volvulus (14%)

Long segment Hirschsprung's(2%)
Others (6%)

NECROTISING ENTEROCOLITIS (35%)

One of the most common gastrointestinal emergencies in the

newborn infant.

Premature neonates that results in inflammation and bacterial

invasion of the bowel wall.




INTESTINAL ATRESIAS (25%)
Congenital complete blockage or obstruction anywhere in the

intestine.

Duodenal, jejunal, ileal- usually treated by resection and end

to end anastomosis.

Some develop severe
disruption- large part atretic.

In about 10%- lack dorsal

mesentery and assume a

spiral like an `apple peel'






GASTROSCHISIS (18%)

Fetal bowel eviscerates through a narrow

abdominal wall defect.

Exposed to amniotic fluid;

associated with other malformations;

tight abdominal compartment.

MALROTATION WITH MIDGUT VOLVULUS


MANAGEMENT

Requires a multi-disciplinary approach that includes

- neonatologists,

- gastroenterologists,
- surgeons,
- nutritionists,
- pharmacists,
- stomal therapists,
- nurses, etc.

SURGICAL MANAGEMENT

1. Bowel conservation at initial presentation.
2. Bowel lengthening surgeries.
3. Intestinal transplantation.




BOWEL LENGTHENING SURGERIES

Longitudinal intestinal
lengthening and tailoring
(LILT) procedure(BIANCHI 1980).

- Doubles bowel length.
- Improves peristalsis.

- Anastomotic leak
- Anastomotic stenosis
- Fistula formation
- Sepsis

BOWEL LENGTHENING SURGERIES

Serial Transverse Enteroplasty

(STEP) ? creates a longer and

narrower intestine.

- - Staple line leak
- Hematoma
- Bowel obstruction
- Abscess


INTESTINAL TRANSPLANTATION

Last resort in irreversible liver and intestinal failure.

Types :
1.

Isolated intestine

2.

Combined intestine and liver

3.

Multivisceral



INTESTINAL TRANSPLANTATION

Complications

- Acute rejection,

- Infection,

- Graft-versus-host disease, and

- Post-transplant lympho-proliferative disease.