THE EFFECT OF SUCKING LOLLIPOPS ON RETURN OF BOWEL FUNCTION AFTER ELECTIVE DISTAL BOWEL SURGERY IN CHILDREN.

BACKGROUND-The phenomenon of cessation of coordinated bowel motility, commonly called as paralytic ileus is well known after certain surgeries. While procedures that involve direct manipulation of gut are almost always associated with post operative paralytic ileus, even orthopaedic surgeries may also cause post operative paralytic ileus. It contributes signicantly in prolonging hospital stay and is associated with abdominal distension, respiratory compromise, nausea and vomiting. Number of pharmacological and non pharmacological agents have been tried to reduce the post operative paralytic ileus. We studied the effect of sucking lollipop on the return of bowel function in children undergoing distal bowel surgery. AIM-To study effect of lollipop sucking on return of bowel function in children undergoing distal bowel surgery in terms of time to return of bowel, passage of stool per anal. MATERIALAND METHODS-Patients undergoing distal bowel stoma closure were assigned to two groups. The experimental group patients were given lollipops 6 hrs postoperatively, time to return of bowel sound and rst passage of stool was noted and analysed. RESULTS-Mean time to return of bowel sounds in the experimental group was 50.25 + 6.016 hrs, while in control group was 65.87 + 8.83 hrs, difference was statistically signicant (P<0.0001).Mean time to passage of stools in experimental group was 72.312 +12.644 hrs , while in control group was 88.25 + 8.38 hrs. difference was statistically signicant(P=0.0002) . CONCLUSION- Sucking lollipop is a safe and effective in reducing duration of post operative paralytic ileus in paediatric patients undergoing elective bowel surgery.

Early Postendoscopic Transverse Colo-Colonic Intussusception

Intussusception is defined as telescoping of the proximal bowel (intussusceptum) into the lumen of the distal bowel, otherwise called the intussuscipiens. While it is one of the most common causes of intestinal obstruction in children between the ages of 3 months and 6 years, intussusception accounts for about 1% of such cases in adults. Intussusception is idiopathic in 8–20% of patients and most commonly occurs in the small intestines in adults. We describe the unique case of a colo-colonic intussusception in a 54-year-old female patient 1 week after a colonoscopy for suspected inflammatory bowel disease. The discussion focuses on the presentation and management options of intussusception.

Preliminary Use of Indocyanine Green Fluorescence Angiography and Value in Predicting the Vascular Supply of Tissues Needed to Perform Cloacal, Anorectal Malformation, and Hirschsprung Reconstructions

Introduction Reconstructive techniques for cloaca, anorectal malformations (ARM), and Hirschsprung disease (HD) may require intestinal flaps on vascular pedicles for vaginal reconstruction and/or colonic pull-throughs. Visual assessment of tissue perfusion is typically the only modality used. We investigated the utility of intraoperative indocyanine green fluorescence angiography (ICG-FA) and hypothesized that it would be more accurate than the surgeon's eye. Materials and Methods Thirteen consecutive patients undergoing cloacal reconstruction (9), HD (3), and ARM repair (1) underwent ICG-FA laser SPY imaging to assess colonic, rectal, vaginal, and neovaginal tissue perfusion following intraoperative visual clinical assessment. Operative findings were correlated with healing at 6 weeks, 3 months, and 1 year postoperatively. Results ICG-FA resulted in a change in the operative plan in 4 of the 13 (31%) cases. In three cases, ICG-FA resulted in the distal bowel being transected at a level (>10 cm) higher than originally planned, and in one case the distal bowel was discarded, and the colostomy used for pull-through. Conclusion ICG-FA correctly identified patients who might have developed a complication from poor tissue perfusion. Employing this technology to assess rectal or neovaginal pull-throughs in cloacal reconstructions, complex HD, and ARM cases may be a valuable technology.

The approach to a neonate with suspected intestinal obstruction: the pediatric surgical perspective

In this article, the possible pitfalls while evaluating a new-born with intestinal obstruction are reviewed and a diagnostic algorithm is proposed. The difficulties include the finding of an otherwise well child in most of the surgical problems and the fact that many signs are subtle. The diagnosis of distal bowel obstruction rests on proper radiological interpretation. The new-born with features of intestinal obstruction poses a diagnostic challenge to the neonatologist and paediatric surgeon. But, the systematic interpretation of history, physical examination, radiograph and contrast imaging in select cases will enable a proper and timely diagnosis.

Biliary Tract Abnormalities as a Cause of Distal Bowel Gas in Neonatal Duodenal Atresia

Background. The presence of distal bowel gas in an infant does not exclude the diagnosis of duodenal atresia. Case Presentation. We report a term neonate with Down syndrome. The infant developed vomiting and cyanosis with each feeding soon after birth. Plain film abdominal X-rays showed a nonspecific gas-filled stomach and small bowel. Duodenal atresia and an anomalous common bile were noted on an upper GI study and exploratory laparotomy. Conclusion. In the absence of a “double bubble” appearance and intestinal gas distally on a plain radiograph, one must not exclude duodenal atresia as the differential diagnosis.