Intestinal Obstruction Repair

 Definition

Reestablishment of intestinal patency in nay number of conditions that create a blockage of the intestinal tract.

Discussion

• Intestinal obstruction is the most frequent gastrointestinal emergency requiring immediate surgical intervention in the newborn.
• Symptoms may include emesis, abdominal distention, and failure to pass flatus and meconium.
• The repair of an intestinal obstruction may include:

• 1. Untwisting of a volvulus.
  2. Division of intestinal band.
  3. Release of an internal hernia.
  4. Resection of bowel with anastomosis.
  5. Creation of an intestinal stoma.

• Surgical intervention should be performed within the first few hour of life, since delay may severely increase the risk of major complications.

Positioning

• Supine, with arms restrained at the side.

Packs/ Drapes

• Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.

Instrumentation

• Pediatric laparotomy tray
• Hemoclip

Supplies/ Equipment

• Thermal blanket with control unit
• Thermal sheets, head covering
• Basin set
• Handheld cautery
• Blades
• Needle counter
• Dissector sponges
• Solutions
• Sutures

Procedure

1. The abdomen is open through an appropriate incision related to the anatomic area that is obstructed.
2. With atresia or stenosis, the entire bowel is examined to rule out multiple areas of involvement.
3. For duodenal artresia, a paramedian or transverse incision is made in the upper abdomen.
4. Bypass of the obstructed duodenal segment is usually preferred over resection.
5. An antecolic duodenojejunostomy is usually the procedure of choice, in which a loop of the proximal jejunum is brought anterior to the transverse colon and to the side of the distended proximal duodenum.
6. A side to side anastomosis is fashioned in one or two layers according to the surgeons preference and size of the small jejunal lumen.
7. The abdomen is closed in a routine fashion.

Perioperative Nursing Considerations

• Separate all instruments associated with the anastomosis and follow bowel technique protocol.
• Check all equipment to promote safety and avoid prolonging anesthesia.
• Patient needs to be prepared physically and mentally.
• Circulator should confirm the operative side with the patient.