ENTERECTOMY (RESECTION FOR CONGENITAL

ATRESIA)

REASON FOR VISIT:

o Bilious emesis
o Abdominal distention (in distal atresias)
o Jaundice (32%)
o Failure to pass meconium in the first 24 hours
o Dehydration, manifested by sunken fontanel and dry membranes
o Decreased urine output (best clinical indication of tissue perfusion)
o Tachycardia
o Decreased pulse pressure
o Low-grade fever
o Neurological involvement, manifested by irritability, lethargy, or
coma
o Failure to tolerate feedings
o Nausea and Vomiting
o Bilious vomiting
o Intermittent, abdominal pain

RISK ASSESSMENT

• Family history of bleeding disorders

• Unstable cardiovascular system
• Liable heat control
• Low birth weight
• History of bleeding disorders
• History of allergy to medications
• History of allergy to anesthesia

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• Plain abdominal radiography of the kidneys, ureters, and bladder
(KUB) Upper GI series
• Barium enema study
• Abdominal X-ray
• Ultrasonography
 • Preoperative antibiotics were administered to the patients with
diseases of the heart valves
• Oral feeding was stopped for ____hrs before procedure
• Electrolyte imbalance, fluid imbalance, acid/base imbalance was
corrected by using the intravenous infusion
• An orogastric tube was placed for gastric decompression and to
avoid aspiration
• Frequent nasopharyngeal aspiration was done to keep airway
clear
• Part was prepared and draped in sterile fashion

ANESTHESIA:

General anesthesia

POSITION OF THE PATIENT

Supine position

THE PROCEDURE

OPEN LAPARATOMY

• The abdomen was entered through a supraumbilical transverse

incision
• The entire intestine was delivered through the incision
• Type of atresia is noted and to other anomalies were rule out
• The duodenal atresia/ jejunoileal atresia was present
• Perforation was present
• Perforation was controlled
• Further exploration was done.
• Normal sodium chloride solution into the distal pouch and to milk
it caudally was irrigated
• The intestine was returned to the abdominal cavity keeping the
atretic segment exposed.
• The intestinal length is normal/ reduced
• The dilated proximal pouch was resected, by removing 10-15 cm
of dilated bowel proximal to the atresia
• Instillation of normal sodium chloride solution with a 24-gauge
needle through a pursestring suture into a clamped distal pouch
was done to distend that segment and to reduce the size
discrepancy between the proximal and distal intestine
 • The proximal intestine was transected at a right angle to
maximize its vascularity,
• The distal bowel was transected obliquely and the incision was
continued along the antimesenteric border as a fish mouth to
equalize the size of the openings on both sides for the
anastomosis
• 1- or 2-layer, end-to-back (end-to-oblique) anastomosis was
performed.
• The mesenteric gap was approximated with fine absorbable
sutures by taking care to avoid kinking the anastomosis and
damaging the mesenteric vessels.
• Patency of the anastomosis can be tested by milking intestinal
air through it.
• The intestinal segment was moistened with warm normal sodium
chloride solution and returned to the abdominal cavity.
• The abdominal wall was closed in layers with absorbable sutures.

The removed portion of the bowel is sent to the histological

/pathological examination

FINDINGS:

• Atresia is found in___________ segments.

AFTER PROCEDURE

• Transferred to the neonatal ICU

• Thermoregulation was done with an incubator.
• Oxygen saturation monitored,
• Maintenance fluids were administered.
• The gastric output was closely monitored and replaced volume
for volume.
• Transfusion was administered
• Glucose, hemoglobin, electrolytes, and Bilirubin levels are
frequently monitored
• Phototherapy was done

DURATION

_______hrs.
POSTOPERATIVE CARE

• Take antibiotic treatment as prescribed

• Take pain medications as prescribed

• Observe for any discharge from suture site

• Surgical wound dressings will be kept clean and dry
• Start feeding after _____hrs /days
• Give Vitamin B supplements

COMPLICATIONS

• Infection
• Pneumonia
• Peritonitis
• Sepsis
• Anastomotic leaks
• Functional obstruction at the level of the anastomosis
• Short-bowel syndrome
• Malabsorption
• Steatorrhea

FOLLOW UP

After ______ days