Intra uterine volvulus with Ileal

atresiaSanjay Khope, MS, M Ch, FACS, FIAPS, FISPU

Consultant Pediatric SurgeonGoa, India

www.drsanjaykhope.com

Time of Occurrence• Probably in the fourth month of IUL• Some times dilated jejunal loops are seen on antenatal USG• May also have polyhydramnios• Postnatally present with bilious vomiting• Abdominal distension • Not having passed meconium• visible jejunal peristalsis

Diagnosis

• Visible small bowel peristalsis• Per rectal catheter no meconium staining• Plain X-ray abdomen Vertical position “Baby gram”• Non Uniform gas pattern with multiple fluid levels• Intra-abdominal calcification or granular appearance• Barium enema showing “Micro colon” most

important confirmatory investigation.

Surgery after stabilization

• Hydration • Fluid Electrolyte management• Rule out sepsis( Septic Screen)• Cross match Blood ( bowel resection, adhesiolysis,

associated sepsis)• Pre-anesthetic evaluation• CAUDAL ANESTHESIA “Single Shot”

Surgical Procedure

• Laparotomy• Resection of necrosed segment , adhesiolysis• Type of atresia• Rule out distal atresia• End-to-back anastomosis of “Dennis Browne”

Post operative Care

• IV Fluids, electrolyte fluids• Blood transfusion if needed• NG tube drainage for sufficient time may be 3-4 days• Rectal stimulation to establish peristalsis• To diagnose NICU related issues• Gradual feeds

Radiology

SINGLE LYER END TO BACK ANASTOMOSISOFDENNIS BROWNE