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A3 Summarizing project

Malrotation

Batool Shwayat

Malrotation and developmental abnormalities of the umbilicus

Malrotation : there is arresting of the rotation of the cecum at 180 degrees . so the cecum will be in the
Right hypochondrium in front of the duodenum .

Ladds band : (abnormal ) band

- could be asymptomatic .
Family history play a role .
may be associated with other congenital anomalies.

between cecum-duodenum , this band


will compress the 2nd part of the
duodenum leading to intermittent
obstruction.

Symptoms :
1- Duodenal obstruction ( tight band ) : bilious vomiting , abdominal distension and delayed passage of
meconium .
2- Intermittent obstruction ( not very tight ) : partial twisting of the mesentry .
3- volvulus : complete twisting (the most dangerous ).

Dx: x-ray(gasless abdomen ) , barium meal , barium enema .


Tt: pre op (IV fluid , NPO ,Antibiotics ) and surgery .

Volvulus Neonatorum
Causes: the mid gut rotate around its mesenteric attachmet = less dramatic symptoms.
or when the mid gut rotate many times .
Results: Mechanical obstruction: when the band compresses the 2nd part
Ischemic obstruction : no blood supply = strangulation
Tt : in early stage : derotation ( blood supply is normal )
Late stage : resection (gangrenous ).

Vomiting in the First Month of Life

1234-

Blie stained : intestinal obstruction


Projectile : infantile pyloric stenosis .
Persistent
Blood stained : reflux,HH, ulceration . or if it is associated with weight loss
Non-surgical causes
-neonatal infections
-adrenogenital syndrome

surgical causes
- neonatal intestinal obstruction .
- sphincteric disorders :1-pyloric stenosis (most imp)
2-GERD :with or without HH
3-Achalasia in older age group.

pyloric stenosis : 3 symptoms : projectile vomiting / failure to thrive /constipation.


2 signs : visible peristalsis ( left to right )/ palpable tumor (not tender,firm,mobile)
Tt:

-correction of fluid and electrolytes


-pyloromyotomy (Ramstedts operation ): cut the serosa and break the muscles.

Umbilical and paraumbilical hernias :

Umbilical
Very common( neonates and infant)
Spontaneous closure
Tt: - conservative: if the diameter is less than
1cm.
-Surgery :if the defect is wide after the 2nd
year or if it is enlarging
Cause : failure of the umbilical cicatrix to
contract or to close

paraumbilical
Less ( adults)
Not closed spontaneously
Surgery is indicated

Defect in the lina alba

Discharging Umbilicus

blood :
- Umbilical granuloma : blood +pus +red lesion
-at the site of the cut of the umbilical cord
-tt: cautery +antibiotics

-umblical polyps :
- persistence of omphalomesentric duct
- tt : excision

Complications : - sepsis
the inflammatory process pass deeply along the Portal vein= portal vain
thrombosis =portal HTN= esophageal varices= hematemesis.

Urine : -patent urachus : fistula between the bladder and the umbilicus
Tt : excision
Feces : persistence omphalomesentric duct .

Developmental abnormalities of the umbilicus:


Omphalocele (exomphalos)

Gastroscisis

Covered by a membrane ( peritoneum +amniotic m. )


In the first 3 hrs : transparent

No membrane

other anomalies : 35-50%


heart/ skeletal / down syndrome

10%

Large defect (2-15 cm)

2-5 cm

Types : major omphalocele : intestine + liver


Medium : intestine only
Minor : a loop of the intestine only

Intestine +stomach (Intestinal loops is


shortened and there is intestinal atresia )

Complications :
contamination + heat loss + fluid loss

contamination + heat loss + fluid loss

Tt: IV fluid +NPO +NG tube +electrolyte balance


+surgery

IV fluid +NPO +NG tube +electrolyte balance


+surgery

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