15 month old child present with sudden vomiting after feeding then relived for some time. Xray after 2days. Didn't passes stool or gas for last 2days. Usg finding intestinal obstruction. The child had congenital jejunal atresia, had diamond shaped jejunojenuostomy. No morbidity in between. Management of this case.

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As child is already operated for jejunal atresia with jejunojejunostomy done. Now presenting with acute intestinal obstruction with multiple air fluid levels. Possibilities could be stromal obstruction, Adhesion obstruction, internal herniation. A MRI scan will be helpful. If conservative treatment fails in 48 hours of RT Suction, NPO , IV fluids, antibiotics an Exploratory laparotomy is indicated before serious gangrene of gut starts

Thank you doctor

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In addition cbc crp blood c/s . Usg abdomen . Seems to b a case of adhesion post jejunojenoustomy . Needs conservative management with naso gastric tube in situ iv fluids npo total parenteral nutrition iv antibiotics inj piperacillin metronidazole ppi . If measures fail . Then surgical management.

Thank you doctor

This child is already operated for jejunal Artesia with jejunojejunostomy done. Now again presenting with Acute intestinal obstruction with multiple air fluid levels. Likely Stromal obstruction.

Admit patient. IV fluids Nasogastric aspiration. Antibiotics Treat conservatively.

Yes patient on iv fluids and antibiotics , on nasogastric aspiration.. Will this conservative treatment will help?

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Intestinal obstruction. Post operative fibrosis.

Intestinal obstruction. Multiple air fluids levels.

Patient needs contrast study..... Contrast if reaches in caecum or large bowel after 24 hrs..... Patient can be managed conservatively....... If not,, laparotomy is the only option

Stenosis at anastomotic is a large possibility Stabilise check hydration and electrolytes and take up for laparotomy

Thank you doctor

If it doesn't help laparotomy

Intestinal obstruction. Need surgical help.

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