Mirella & Lino Saputo Foundation Chair in Pediatric Surgical Education & Patient and Family-Centered Care; McGill Univ
#CBCLIPS Episode 48 Case Based Clinical Learning In Pediatric Surgery A 9-month old girl with Trisomy 21 presents with acute non-bilious emesis, worsening over 5 days. She has a history of intermittent vomiting and poor weight gain since birth, diagnosed and treated as gastro-esophageal reflux disease. Exam shows a deyhdrated, but non-toxic baby weighing 5.4 kg (15th percentile). Her abdomen is soft and non-tender. Laboratory tests show a severe hypokalemic hypochloremic metabolic alkalosis and hemoconcentration. A films is shown below. How would you proceed with this patient? If you use #CBCLIPS, please take 5 minutes to participate in this research survey at the link below. The deadline for submitting your feedback is APRIL 30. Thank you. https://lnkd.in/e_iCe3_J
proximal chronic duodenal obstruction ( proximal gastrointestinal obstruction pylorus or duodenum ) Trisomy 21 indicate towards duodenal obstruction. Interesting finding is “X-ray showing air rim outlining gastric wall” (unusual finding) USG ABDOMEN UPPER GI SERIES 2D echo to rule out associated cardiac anomalies Nil by mouth and Decompression with NG tube preoperative stabilization (correction of fluid and electrolyte imbalance) Strict urinary output measurement Subsequent surgical correction once condition stabilise.
According to gastric time induced volume and trisomy 21 deudunal web is one important DDx.
On the abdominal thoraco, gastric distension and passage of air into the intestines is observed. What to do:Hospitalization, gastric tube conditioning, correction of hydroelectrolyte disorders, etc. Abdominal ultrasound and gastroduodenal esosotransit. Most Likely Diagnosis Duodenal Stenosis.
According H/o Down Syndrome can be Proximal duodenal obstruction before papillae of Vatrer or HSP or combination or annular pancreas.
first of all should admit and stabilize the pt by npo plus ng decompression fluid and electrolytes correction then do us as simple and non invasive to exclude hps the. do upper contrast swallow meal and follow through ddx : 1 doudenal fenestrated web 2 HPS 3. GERD
Partial dudenal obstruction with pneumatosis intestinalis.
M.D at Naples Comunity Hospital
4mothe gas pattern within the duodenal loop, small and large bowel is non specific . linear gas collection noted surrounding the gastric fundus ,greater gastric curvature ( superior to the gas filled transverse colon ) and around the duod. cap . pattern may suggest trapped free air within the lesser and greater sacs. a result of spontaneous gasro- esophageal rupture or post intervention . non contrast abd. and pelvic CT, will be the most helpful investigation. thanks