Rare Forms of Intestinal Obstruction in Children

Abstract

The article analyzes two rare cases of acquired intestinal obstruction in children. In the first child at the age of 2 years, who suffered a retrosternal total coloesophagoplasty for extended post-burn chemical esophageal stenosis, early postoperative adhesive intestinal obstruction appeared on the 8th day of the postoperative period, which was eliminated laparoscopically. The next day, against the background of drug stimulation of the intestine, a small intestinal invagination developed, diagnosed with ultrasound examination. Relaparotomy and disinvagination were performed.The second patient, the 15 years old girl, who had suffered from closed abdominal injury and a pancreatic injury, manifested the signs of high partial intestinal obstruction a day after the trauma occurred. Initially, its cause was considered to be hematoma of the omental bursa. Fibrogastroduodenoscopy (FGDS) and X-ray diagnostics did not reveal the cause of intestinal obstruction, but after FGDS procedure the patient’s condition improved within 3–4 days, and then the clinical signs of small bowel obstructive adhesion confirmed by X-ray and laparoscopy. With laparoscopy in the middle section of the small intestine, a hyperinflate “whitish” section about 12 cm long, dense in palpation, was identified, which was the cause of obstruction. Through minilaparotomic umbilical access from the abdominal cavity, a loop of the jejunum with a foreign body inside was exteriorized. With transverse enterotomy trihobezoar 10×4×4 cm was removed from the lumen, which moved from the stomach and led to obstruction of small intestine. The outcome of the treatment was good in both cases.

Large foreign body – pencil in the pelvic cavity of a girl two years

“…Последнее трудноосуществимо согласно всему вышесказанному. Нельзя было исключить и перфорацию кишечной стенки как самим инородным телом, так и последствиями его пребывания в брюшной полости (сдавление кишки и формирование «пролежня» на ее стенке), а это, в свою очередь, потребовало бы выполнения резекции поврежденного участка кишечной трубки с дальнейшим наложением межкишечного анастомоза, что требует значительного объема пространства для манипуляций, которого у врача-хирурга могло не быть в случае эндоскопического выполнения оперативного вмешательства [25].…”