16 month child with vomitting

A 16-month girl with vomiting x2 days. Became lethargic. Dx Intussusception. Emergency surgery x1 week ago. 2nd emergency surgery for leakage at surgical site 24 hrs later. Temporary colostomy. Currently in the hospital with fever > 101, bloat/distention, pain, and no BS. NGT with approximately 300-500ml dark green drainage per 24hrs. NPO. Receiving Tylenol for fever, tordol or morphine for pain and zosyn for infection. She passed x1 dark old blood-colored discharge from anus on day 7. It also has a mucous fistula next to the navel. What can be done for the lack of peristalsis? Now day 8; the patient is not improving. What are your suggestions?

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Do Cbc crp blood c/s urine r/e n c/s serum electrolytes . Check for hypokalemia paralytic/septic ileus/peritonitis . Monitor urine output. Maintain hydration. Usg abdomen. Total parenteral nutrition. Might need whole fresh blood transfusion too. Check for features of hypovolemic/septic shock. Give one dose of vit k.
Conservative management only.... Maintain strict input & output chart Careful monitoring of vitals Send CBC , LFT ,RFT , BLOOD CULTURE, serum Electrolytes. change antibiotics according to culture reports. NTG aspiration every hourly. Repeat xray & usg for every 48hrs.
? PARALYTIC ILEUS .. CAUSE MAYBE.. ?INTESTINAL INFECTION..VIRAL/ BACTERIAL.. ? ELECTROLYTES LOSS, HYPOKALEMIA..
Tnx Dr A Dutta
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Yes ,it is paralytic ileus,I agree with Dr kute Ankush sir
Stop giving Tordol or Morphine sir, otherwise it will worson stasis of gut.Treatment of course remains conservative considering her age and two major surgeries already performed.Good antibiotic cover to be given alongwith NGT and that's what is being done.Hope she recovers.
Strict standards of I/O charting , NPO, upgrade iv antibiotics to meropenam, metrogyl. Send bld culture. ? Paralytic ileus ? Speticimia associated surgical intervention. Regular montiring of vitals , serum electrolytes, sepsis markers, USG abd to reveal
Check electrolytes. hypokalemia paralytic ileus may be there. Maintain strike I/O chart,proper hydration, coverage for anarobic organism and change antibiotics according to culture report
Stop morphin See for electrolyte imbalance Infuse ringer lactate fluid as the amount of billious aspirate Add calcium gluconate 4ml/kg in 24hrs in ivfluid. Rest same as u advised.
Rule out 1)any electrolyte imbalance causing aperistalsis.2)any perforation, which could be causing these signs.
Hyponetrmia •? Antibiotics ztrictly after culture and zensetivity reports.
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