morphine and Duodenal-Obstruction

The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower gastrointestinal (GI) tract obstruction in neonates and infants.. A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome method comparing radiography, upper GI contrast study, and ultrasound in the detection of upper GI tract obstruction such as duodenal atresia and stenosis, jejunal and ileal atresia, and malrotation and volvulus. The same methods were used to compare radiography and contrast enema in the detection of lower GI tract obstruction such as meconium plug syndrome, meconium ileus, Hirschsprung disease, and imperforate anus. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies.. There were no sensitivities/specificities available for the imaging diagnosis of duodenal atresia or stenosis, jejunal or ileal atresias, meconium plug, and meconium ileus or for the use of cross-table lateral radiography for the diagnosis of rectal pouch distance from skin in imperforate anus. The retrieved sensitivity for the detection of malrotation on upper GI contrast study is 96%, and the sensitivity for the diagnosis of midgut volvulus on upper GI contrast study is 79%. The retrieved sensitivity and specificity for the detection of malrotation with volvulus on ultrasound were 89% and 92%, respectively. The retrieved sensitivity and specificity for the detection of Hirschsprung disease on contrast enema were 70% and 83%, respectively. The retrieved sensitivity of invertogram for the diagnosis of rectal pouch distance from skin in imperforate anus is 27%. The retrieved sensitivities of perineal ultrasound and colostography for the diagnosis of rectal pouch distance from skin in imperforate anus were 86% and 100%, respectively.. There is limited evidence for the imaging diagnosis of duodenal atresia and stenosis, jejunal and ileal atresias, meconium plug, meconium ileus, and imperforate anus, with recommended practice based mainly on low-quality evidence or expert opinion. The available evidence supports the use of upper GI contrast study for the diagnosis of malrotation and volvulus, with ultrasound as an adjunct to diagnosis. Contrast enema is useful in the investigation of suspected Hirschsprung disease, but a negative study does not outrule the condition. Colostography is the investigation of choice for the work-up of infants with complex anorectal malformations before definitive surgical repair.

Topics: Comparative Effectiveness Research; Contrast Media; Duodenal Obstruction; Humans; Ileus; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestinal Volvulus; Meconium; Radiography, Abdominal; Sensitivity and Specificity; Ultrasonography

Many different pathophysiologic conditions can affect the neonatal intestinal tract and ultimately require surgical intervention. The symptomatology is primarily that of bowel dysfunction and obstruction. A thorough understanding of these disease processes is necessary of the managing physician. With this knowledge, a systematic course of resuscitation, evaluation, and treatment can be instituted, usually with predictably gratifying results for patient, family, and physician alike.

Topics: Duodenal Obstruction; Enterocolitis, Pseudomembranous; Fluid Therapy; Hirschsprung Disease; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Jejunum; Meconium; Resuscitation

Topics: Abnormalities, Multiple; Colonic Diseases; Digestive System Abnormalities; Duodenal Obstruction; Esophageal Atresia; Female; Hernia; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestines; Jejunum; Male; Meconium; Megacolon; Mesenteric Cyst; Polyhydramnios; Pregnancy; Pylorus; Radiography; Vitelline Duct

Topics: Anal Canal; Congenital Abnormalities; Cystic Fibrosis; Duodenal Obstruction; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Meconium; Megacolon; Pancreas; Rectum

Topics: Adult; Duodenal Obstruction; Female; Fetal Diseases; Humans; Intestinal Atresia; Meconium; Peritonitis; Pregnancy; Premature Birth; Ultrasonography, Prenatal

The coexistence of duodenal atresia (DA) may mask the antenatal ultrasound findings of meconium ileus (MI) and delay its postnatal diagnosis. We report a rare case of MI in a newborn infant diagnosed antenatally to have trisomy 21 and DA. The diagnosis of MI was only established intraoperatively after the patient showed persistent signs of intestinal obstruction following the surgical repair of the DA.

Topics: Cystic Fibrosis; Diagnosis, Differential; Down Syndrome; Duodenal Obstruction; Duodenum; Fatal Outcome; Humans; Ileus; Infant, Newborn; Intestinal Atresia; Male; Meconium; Radiography

Topics: Duodenal Obstruction; Esophageal Atresia; Humans; Infant, Newborn; Intestinal Atresia; Male; Meconium; Peritonitis

During 13 years, 47 infants were treated for mechanical ileus resulting from intestinal obstruction located proximally to the coecum (duodenal obstruction, malrotation, jejuno-ileal obstruction and meconium ileus). The mortality and morbidity were low. A total of three infants died; all of them in the immediate postoperative period. One infant died on account of rupture of the anastomosis; in two infants, death was caused by pulmonary complications and disseminated intravasal coagulation. Seven reoperations were performed and among these five infants on account of adhesions-/fibrous band ileus. At follow-up examination five infants were slightly underweight and retarded in growth; only one child had troublesome gastrointestinal problems. We recommend the use of antenatal ultrasound in the 30th week of gestation more frequently and always when polyhydramnios is present. This should raise the suspicion of gastrointestinal obstruction. Postnatal screening for associated congenital anomalies should also be done, since these are the most frequent cause of death in this patient category.

Topics: Duodenal Obstruction; Female; Follow-Up Studies; Humans; Ileal Diseases; Infant; Infant, Newborn; Intestinal Obstruction; Jejunal Diseases; Male; Meconium; Prognosis

Intestinal obstruction and necrotizing enterocolitis are two of the most common surgical emergencies of the gastrointestinal tract. This article reviews the signs and symptoms of these conditions and presents guidelines for their management.

Topics: Colon; Diagnosis, Differential; Duodenal Obstruction; Emergencies; Enterocolitis, Pseudomembranous; Fluid Therapy; Humans; Ileum; Infant, Newborn; Infant, Premature, Diseases; Intestinal Atresia; Intestinal Obstruction; Jejunum; Meconium; Postoperative Complications

Intestinal surgery in the foal is seldom necessary but some conditions in which it is essential are well recognized. The foal is a good surgical subject but success depends mainly on operating promptly before irreversible degenerative changes take place. Exploratory laparatomy is recommended whenever mechanical obstruction is suspected. Indications fall broadly into two main categories: 1. Cases arising from congenital defects. These form a miscellaneous group and present considerable difficulties in diagnosis and effective treatment. 2. Cases related to acute onset of obstruction, mainly due to volvulus or torsion. By far the most important condition in this category is volvulus of the ileum close to the ileocaecal valve. Aetiological factors are discussed, and the value of resection of affected small intestine and creation of a new jejuno-caecal opening is indicated. It is suggested that with improvement of such techniques it will be possible to save a higher proportion of foals suffering from mechanical intestinal obstruction.

Topics: Abdomen; Anesthesia; Animals; Cecal Diseases; Duodenal Obstruction; Hernia; Herniorrhaphy; Horse Diseases; Horses; Intestinal Diseases; Intestinal Obstruction; Intestine, Large; Intestines; Intussusception; Meconium; Postoperative Care; Pyloric Stenosis; Torsion Abnormality

Topics: Appendicitis; Barium Sulfate; Constipation; Diverticulum; Duodenal Diseases; Duodenal Obstruction; Duodenum; Enema; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestine, Small; Meconium; Megacolon; Preoperative Care; Radiography; Syndrome

Topics: Abnormalities, Multiple; Age Factors; Bile; Child; Child, Preschool; Down Syndrome; Duodenal Obstruction; Duodenum; Esophageal Atresia; Female; Humans; Infant; Infant, Newborn; Meconium; Polyhydramnios; Pregnancy; Vomiting

Topics: Animals; Bile Ducts; Dehydration; Duodenal Obstruction; Duodenum; Gastrointestinal Motility; Humans; Infant, Newborn; Intestinal Atresia; Meconium; Pancreas; Rabbits; Radiography; Thalidomide; Tracheoesophageal Fistula; Vomiting

Topics: Duodenal Obstruction; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestine, Small; Meconium; Megacolon; Mesentery

Topics: Duodenal Obstruction; Humans; Infant; Intestinal Obstruction; Jejunum; Meconium; Megacolon; Posture; Radiography; Vomiting

Topics: Child; Congenital Abnormalities; Duodenal Obstruction; Humans; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intussusception; Meconium; Surgical Procedures, Operative; Water-Electrolyte Balance