Anterior colon duodenojejunostomy

The anterior duodenal jejunum lateral anastomosis is used for the surgical treatment of duodenal atresia and stenosis. Congenital intestinal atresia and intestinal stenosis are one of the common malformations in newborns. It occurs in the embryo 10 to 12 weeks, most of the vacuoles are formed by the epithelium-filled intestinal lumen, and the vacuoles fuse with each other to communicate with the intestinal lumen. This recanalization process creates an intestinal atresia or stenosis, duodenum. Occlusion and stenosis are mostly such embryonic malformations. In addition, when the fetus has developed completely after 3 months, during the intrauterine growth, due to different diseases such as volvulus, cable compression, intussusception, mesenteric developmental defects or mesenteric vascular embolism, intra-abdominal infection, etc. Causes of intestinal necrosis, perforation lesions, and then self-repair, which is the cause of the formation of empty, ileal atresia and stenosis, some patients can still see meconium peritonitis or meconium intestinal obstruction. Intestinal atresia and intestinal stenosis are most common in the lower jejunum and ileum, followed by the duodenum, which is less common in the colon. Mostly single lesions, but also multiple atresia. Treatment of diseases: congenital intestinal atresia and colonic atresia Indication Surgery is the only treatment for congenital intestinal atresia and intestinal stenosis. If the intestine atresia is not operated in time, it will die about 1 week after birth, so it is ready to be operated as soon as possible after diagnosis. Intestinal stenosis is based on the condition and is actively prepared for surgery. Preoperative preparation 1. Nasogastric tube decompression to prevent vomiting and aspiration. 2. The sick child often has pneumonia and atelectasis. It is necessary to fully inhale oxygen and drain the sputum. In severe cases, the trachea should be intubated, the secretions of the respiratory tract should be removed, and the breathing should be assisted. Pay attention to the humidity of the inhaled gas. 3. Pay attention to heat preservation, especially for children with low body temperature at admission. It is necessary to restore body temperature as soon as possible before surgery. 4. Correct the imbalance of water, electrolytes, acid and alkali caused by frequent vomiting. 5. Application of antibiotics, vitamin K and vitamin C. 6. Match the blood 50~100ml for use. 7. Establish an intravenous infusion pathway. Surgical procedure After laparotomy, after clearing the lesion, the intestines of the proximal duodenal atresia were fully revealed, and the jejunum from the duodenal suspensory ligament (Treitz ligament) 10-15 cm was lifted. Adjacent to the enlarged anterior wall of the duodenum. The anastomosis was anastomosed with the duodenal duodenal anastomosis (lateral side) and the posterior duodenal jejunum. complication 1. Anastomotic obstruction: The cause may be anastomotic edema, excessive varus, meconium obstruction, and insufficient proximal resection of the intestine, and poor peristalsis. If you have good decompression and nutritional support for intravenous or enteral feeding tubes, you can wait patiently and observe them. Otherwise, you must re-explore and correct within 1 week. 2. Anastomotic leakage: a serious complication. In the case of nutritional support, a small intestinal leak is not accompanied by a manifestation of peritonitis, and sometimes non-surgical treatment can be cured. However, if the leakage is large and the peritonitis is obvious, it must be treated in time. 3. Intestinal obstruction caused by intestinal adhesion: It is more likely to occur in children with meconium peritonitis, and surgery is necessary when non-surgical treatment is ineffective. 4. Pneumonia: General respiratory infection or aspiration pneumonia are serious complications and must be actively prevented and treated. 5. A small number of patients with intestinal atresia did not find the diaphragm-type stenosis in the proximal side of the atresia. There was no complete obstruction in the early postoperative period. With the development of the sick child and dietary changes, symptoms or effects of incomplete obstruction occurred after several months or even years. It only appeared when nutrition was developed, and another operation was performed.

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