Duodenal obstruction


 * Ladduv syndrom.png belongs to the so-called proximal intestinal obstructions - these are characterized by - minor distension of the abdomen and permanent explosive vomiting.
 * In the case of intestinal obstruction below the level of 15 cm from the beginning of the jejunum - the so-called distal obstruction - bloating, distension of the abdomen dominates, vomiting comes later.
 * Obstruction of the duodenum can be caused by atresia (more often) or stenosis.
 * It is more common in Down syndrome and in immature children.
 * The obstruction is usually located below the major papilla of the duodenum.
 * Otherwise, obstruction can also occur with incomplete rotation of the intestine, volvulus congenitalis, with pancreas annulare.
 * Clinical picture:
 * Obstruction of the duodenum is closely related to the circulation of amniotic fluid - in all cases of obstruction, polyhydramnios is detected during childbirth.
 * Therefore, every time polyhydramnios is found, we have to aspirate the stomach contents with a tube after birth - and if it is more than 15 ml, we suspect proximal intestinal obstruction.
 * The main symptom – projectile vomiting (with atresia it starts immediately after birth, with stenosis after several hours).
 * Vomit is a yellowish admixture of bile.
 * Sometimes we see a peristaltic wave similar to that of pylorostenosis.
 * Distention - only in the epigastrium or absent.
 * Laboratory – hypochloremic alkalosis, Na + and K + depletion;
 * with excessive vomiting of intestinal contents, MAl can pass into MAC and the disruption of the environment is further aggravated.
 * Diagnosis - ultrasound can be detected already intrauterine.
 * After birth, the best native x-ray image of the abdomen in the hanging position (the contrast material is air swallowed by the baby) at the time of birth.
 * Normally - immediately after birth, there should be air in the stomach, within 1 hour in the small intestine, in 4-18 hours in the large intestine.
 * With atresia, the typical picture is of "two bubbles" - one in the stomach area, the other smaller one in the duodenum area.
 * Therapy – surgical – duodenoplasty, duodenojejunostomy,
 * prior to the operation, modification of the internal environment is necessary.

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 * Small bowel obstruction
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