Surgery to treat mid-ileum torsion

The article was consulted professionally by Resident Doctor Le Thanh Tuan – General Department – Share99 Nha Trang International Hospital. The doctor has extensive experience in examination, treatment and surgery of abdominal diseases.

The mediasm is a word used to address part of the digestive tract from the Vater shadow to the middle part of the horizontal colon in the fetus. During the development of the pregnancy, the mediascopy will orbit the axis of the upper hanging artery, fixed to the abdominal wall to form the duodenum under Vater's shadow, the small intestine, the colostomy, the raised colon and the right horizontal half of the colon.

Mediasm twisting is a congenital abnormality in which the intestine rotates and is not completely fixed during the development of the fetus. The entire small intestine and part of the colon are fixed only in the abdominal wall by a narrow hanging network that makes the mediascopy prone to twisting. Mediastative torsion occurs in 0.5-1% of the population, mainly in babies. Clinical erm from asymptoatic to intestinal to twisted intestines. If the intestines rotate badly and there is no intestinal torsion, then the patient has no real symptoms. If the unfinished spinning intestine has a twisted intestine, then there are symptoms. The symptomatic rate is 1/6,000. Mediasmal torsion is often accompanied by conditions such as an intermediate or chronic duodenal obstruction, congenital diaphragm hernia, abdominal wall opening, Meckel divertic fisses, bile dysenteritis.

Mediastular torsion is rare but is a very serious pathology, if not detected and intervened in time, the entire small intestine and part of the young colon can be necrosis. Common manifestations when a child has a mediasm twist are:

• Poorly breastfed babies, often vomiting with many yellow-green epidemics
• Dehydration, malnutrition, severe electrolysm disorder tests
• Tachycardia, rapid breathing, strong breathing
• If the volume of circulation is lost, small intestine anemia progresses, the child may develop septic shock with manifestations such as hypotension, respiratory failure, black stools, vomiting blood, metabolic acidosis, leukocyukocysis, thrombocyletes,…

Children with a diagnosis of mediastic torsion should be quickly operated on, except in the case of coadenemia. There are two forms of mid-ileum torsion surgery: open surgery and laparoscopic surgery. Before surgery, the child will receive water, electrolytic, gastric straws, antibiotics, and enough tests to assess the overall condition.

2.1 Surgery to treat mid-ileum torsion by open surgery

The child is located on the operating table, the surgeon stands on the right, the surgeon stands on the left side of the child. After anesthesia, the doctor makes an incision of the skin horizontally below the right flank. The surgeries include:

• Torsional removal
• Ladd ligament removal, duodenal release, general mescosa wide load
• Appendicect
• Insert the left ileum and fix it into the abdominal wall

2.2 Laparoscopic surgery for mediastinal torsion

• The child is lying on the operating table, the surgeon stands on the side of the child's leg, the woman holds the camera standing on the right side of the surgeon. The screen is located on the opposite side of the surgeon.
• Place 3 trocars in the abdomen in the umbilical positions, lower the right flank and lower the left flank. Inflatable pressure remains between 7-9 mmHg with a flow of 2-3 l/min depending on age. The surgery is similar to open surgery.

Laparoscopic surgery is less invasive, the child recovers quickly, the scar is small and quickly heals, the incidence of accidents is low. However, in order to perform laparoscopic surgery, it is necessary to have modern equipment, the surgeon is highly specialized, skilled, trained in laparoscopic surgery.

Children after surgery should maintain their temperature with an incubator, water balance, electrolytes if necessary. Use antibiotics to fight bacterial infections.

Nourish the child intravenously completely in the first 3 days. Perform intermittent suction of gastric juice, until the bile-free solution can feed the baby in increasing quantities. If there is a gastric cathetro placed through the mouth, pump milk through the cathex from the 3rd day after surgery for early feeding.

Closely monitor the condition of the child, if there are complications of intestinal obstruction or intestinal twisting, the surgery will be carried out.

Recommended videos:

Fetal screening – Healthy baby born

SEE MORE:

• Symptoms of Acute Appendicitis
• Complications of acute appendicitis
• Does appendicitis treatment require surgery?