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Pediatric Surgery Care

Bby

By Susheewa Wichaikull

Intestinal Obstruction

Theintestine is made up of the small intestineand the large intestine (colon).The small intestineruns from the stomach to the large intestine.The colon runs from the end of the smallintestine to the anus.The intestine absorbsnutrients and water from the diet.struction o te intestine occurswen ooand water cannot pass through the intestine.

The area of intestine nearest to theobstructionbecomes dilated and non-functioning.If theobstruction is not relieved, it can lead tointestinal gangrene and perforation.in adultsare adhesions, hernias, and colon cancer

While each reason for intestinal obstructionrequires a different treatment, all intestinalobstructions are potentially life-threatening.

Operation

In the case of adhesions,the adhesion is removed,thus relievingthe obstruction. In the case of ahernia,the hernia is repaired. If colon cancer ispresent,cancerous areas are removed, whichalso relieves the obstruction.In all cases, the intestine involved in theobstruction is examined. If an arts of the

Barium

intestine look unhealthy from lack of blood flowduring the period of obstruction, they are removedand the healthy ends are reconnected. A patient'srecovery depends on several factors, includingthe cause of the intestinal obstruction and thelength of time prior to relief of the obstruction.

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Meckel's Diverticulum

Meckel’s diverticulum is one of the most commoncongenital abnormalities. It occurs when theconnection between the intestine and the umbilicalcord doesn’t comletel close off durin fetaldevelopment.This results in a small outpouchingofthe small intestine, know as a Meckel’s diverticulum.In most cases, Meckel’s diverticula do not causeany problems.Treatment of a Meckel’s diverticulum involvesresection of the involved portion of the smallintestine. Often, symptoms from a Meckel'sdiverticulum are thought to be due to appendicitis-and the Meckel's diverticulum is discovered only

Treatment

after the operation has begun.The smallintestine is found and the Meckel'sdiverticulum is removed.The intestine is repairedand the incision is closed.Intravenous fluidswill be iven until the atientisable to eat by mouth (after bowel soundsare heard).A nasogastric tube may be in place toempty the stomach. Antibiotics may be given toprevent or treat infection.Discharge from thehospital can be expected within a weekaftersurgery, barring complications.

Congenital megacolon(

Aganglionic megacolon )Hirschsprung’s disease occurs when the specializednerve cells, called ganglion cells(parasympatheticganglion cell)

fail to completetheir normalmigration for the entire length of the bowel duringThe most common causes of

Congenitalmegacolon

(

%) are foundin rectosigmoid.

fetal development.

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Diagnosis and treatment

•In an infant,failureto pass a bowel movement

(meconium) within the first

hoursof lifefirst suggests Hirschsprung’s disease•severe constipation•If Hirschsprung’s disease is suspected, testsare used to confirm the diagnosis. A barium enemamay be performed.

Barium Enema

The contrast material outlines a bowel segmentwithout ganglions (arrows), above whichprestenotic dilatation is visible.Patients diagnosed with Hirschsprung’s diseaserequire an operation. The abnormal portion of

Treatment

te owe usuay rectum an ower coon isremoved and intestine with normal nerve cellsis brought down and attached just above the anus.The operations for Hirschsprung’s disease arereferred to as"Pull-through procedures

because the normal intestine is "pulled through”the pelvis.Theoperation requires

days in the hospital

Usually, the operation can be completedin onestage with no need for a colostomy.In some cases, such as an extremely long segment of abnormal owe orserous necons presen, a temporary colostomy may be created, which isreversed at a later operation.

Nursing CarePre-OperationNPO NSS enema Record I/O

การพยาบาล

ก ่อนผ ่าตัด

สวนล ้างด ้วย

0.9% NSS 300 ml

เช้าเย็น

ใช้สายยางเยอร์

10-12

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นิ ว

Record Intake Output

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