Necrosis Intestinal Infantil Post Traumática

Abstract

Femenine patient of 1 year 10 months, born and resides in Ambato (Pasa), product of second poorly, controlled pregnancy feat, well tolerated, domiciliary eutocic birth at nine months gestation, crying immediately after birth, underfed, imunizations complete for the age, adequate psychomotor formation, no personal or family history of pathologic significance.

Patient 48 hours ago suffered a fall down steps (aproximately 5 steps) impacting their abdomen on concrete, 24 hours ago displays abdominal distention, refuses to eat, is found hyperactive, so they will lead to the emergency of the Provincial General Teaching Hospital in Ambato, the physical exam FC 100 beats a minute, FR 60 a minute, axillary temperature 36.2 0C, weight 10.3 kg.

The examination hyperactive, irritable, oropharynx erithmatous, congestive, abdomen distended, RHA absent, tympanic percusión painful. Placed nasogastric tube being obtained 200 ml of greenish liquid, with a diagnostic of acuto abdomen obstruction and normocytic anemia, recieve hydration, analgesic, antibiotic therapy (Ampicilin and Sulbactam), labaratory exams, alkaline phosphatase: 292u/lm TP:24, 33, HB:8.4, HTC:26.4, leucocytes:22430, neutrophils: 17.59.

Evaluated for surgery hyperactive is established patient with respiratory dificulty, abdomen very distented, RHA absent. In the X-ray of abdomen air fluid levels it is noted.

Exploratory laparotomy found a heamoperitoneum of aproximately 800 ml in abdominal cavity, ruptura of intestinal meso with active bleeding, intestinal necrosis of aproximately 60 cm of the Treitz angle, rest of intestine with signs of edematous ischemia, spleen and liver of normal characteristics, with ileus anastomosis- ileal, released 60 cm from the angle of treitz and abdominal wash.

Continues hospitalized in ICU for postsurgical control during four days displaying good clinical evolution, later it is transferred to Pediatric Services with diagnosis of closed trauma of the abdomen, ruptura of the intestinal meso, intestinal necrosis with ileus anastomosis- ileal, released after 28 days of hospitalization with frank improvement of their situation.