Helicobacter pylori - Portal Neonatal

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Congenital problems of the gastrointestinal tract
intestine a second-look laparotomy can be
performed after 24 h.
In cases of malrotation not complicated by volvulus,
the procedure of choice for most surgeons is
the Ladd’s procedure. This involves division of all
adhesions or adhesive bands between the cecum,
duodenum and parietal peritoneum, broadening of
the mesenteric base around the superior mesenteric
artery and repositioning of the intestine
within the abdominal cavity so that the duodenum
is on the right and the cecum lies in the left upper
quadrant. It has become customary to perform an
appendectomy, owing to the difficulties of diagnosis,
should appendicitis develop later in life.
Meconium ileus
Meconium ileus is a common cause of neonatal
intestinal obstruction and the most common cause
of antenatal intestinal perforation. 19 It should be
included in the differential diagnosis of infants
presenting with GI tract obstruction. In approximately
80% of cases it is associated with cystic
fibrosis. 20–22 The underlying defect in cystic fibrosis,
an abnormality in a transmembrane chloride
channel, results in the production of abnormally
viscid and sticky meconium. This meconium
sticks to the intestinal mucosa causing intestinal
obstruction usually occurring late in gestation.
Why some infants with cystic fibrosis do not
develop meconium ileus is unclear. Meconium
ileus can be classified as: ‘uncomplicated’, when it
is limited to intraluminal obstruction caused by
the abnormal meconium; or ‘complicated’, when it
is associated with intestinal atresia, volvulus or
meconium peritonitis.
Clinical features
In cases of uncomplicated meconium ileus, the
infant usually presents shortly after birth with
symptoms of lower gastrointestinal obstruction
including abdominal distension and vomiting
which may or may not be bile stained. The rectum
may be empty and narrow and the infant does not
pass meconium. If meconium ileus is complicated
by volvulus, intestinal ischemia or perforation, the
infant can be systemically unwell with acidosis,
undergo hypovolemic shock and may require
ventilatory support. Abdominal X-ray showing
dilated intestinal loops and occasionally abundance
of meconium in the right lower quadrant are
supportive of the diagnosis, as is a gastrograffin
contrast enema revealing a small collapsed colon
(microcolon) and often inspissated pellets of
meconium in the right lower quadrant.
Treatment
In some cases, the gastrograffin enema mentioned
above may relieve the obstruction sufficiently to
be curative. However, a number of uncomplicated
cases and all complicated cases require surgery.
The procedure performed depends on the findings
during laparotomy. Atretic or grossly dilated
segments of bowel may be resected, the inspissated
meconium removed from the intestinal
lumen and the distal bowel flushed through.
Occasionally a stoma is formed to allow intestinal
decompression. Outcome of surgical treatment is
generally good and gastrointestinal complications
are of lesser significance than the pulmonary
disease caused by the underlying cystic fibrosis.
Meckel’s diverticulum
Meckel’s diverticulum is the most common
omphalomesenteric remnant with a reported incidence
of approximately 2%. Of these only a small
proportion become clinically significant. The
diverticulum originates from incomplete obliteration
of the omphalomesenteric duct and exists as a
free-lying diverticulum on the antimesenteric
border of the ileum.
Clinical features
There are a variety of disease entities attributed to
Meckel’s diverticulum including gastrointestinal
hemorrhage, intussusception, diverticulitis and
perforation. The most common presenting
symptom is that of gastrointestinal bleeding due to
excessive acid and pepsin production from an
ectopic gastric mucosa which may be present
within the diverticulum. Bloody diarrhea in the
absence of abdominal pain is the classical presenting
picture. Other complications of Meckel’s diverticulum
are intussusception in which the diverticulum
acts as a lead point, diverticulitis with
symptoms similar to those of appendicitis and
perforation.