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A term baby is born with abdominal distension and bilious vomiting. Abdominal X-rays reveal dilated loops of bowel without air fluid levels, and a water-soluble contrast enema demonstrates a microcolon without contrast reflux into the terminal ileum. A laparotomy is performed on this stable baby with findings as shown. The bowel is in continuity; however, there is an obvious calibre change in the mid ileum, which is associated with viscid, doughy intraluminal content.
The most appropriate next step in management is:
A Seromuscular biopsies for ganglion cells
B End ileostomy above caliber transition
C Enterotomy with meconium evacuation facilitated by 20% N-acetylcysteine (Mucomist) irrigation, with Bishop-Koop ileostomy
D Enterotomy with meconium evacuation facilitated by 5% N-acetylcysteine (Mucomist) irrigation with enterotomy closure
E Loop ileostomy below caliber transition
A term baby is born with abdominal distension and bilious vomiting. Abdominal X-rays reveal dilated loops of bowel without air fluid levels, and a water-soluble contrast enema demonstrates a microcolon without contrast reflux into the terminal ileum. A laparotomy is performed on this stable baby with findings as shown. The bowel is in continuity; however, there is an obvious calibre change in the mid ileum, which is associated with viscid, doughy intraluminal content.
The most appropriate next step in management is:
A Seromuscular biopsies for ganglion cells
B End ileostomy above caliber transition
C Enterotomy with meconium evacuation facilitated by 20% N-acetylcysteine (Mucomist) irrigation, with Bishop-Koop ileostomy
D Enterotomy with meconium evacuation facilitated by 5% N-acetylcysteine (Mucomist) irrigation with enterotomy closure
E Loop ileostomy below caliber transition
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