Perforation of the transverse colon in neonate is a rare finding in clinical practice. We report a case of Idiopathic neonatal colonic perforation in a twenty-one days old, healthy, female neonate without any demonstrable cause. She presented with abdominal distention and constipation. Abdominal radiograph showed massive pneumoperitoneum. On exploration, transverse colonic perforation was found near splenic flexure area. The perforation was closed primarily. Other than inflammatory fibrin flakes the rest of the large intestine and small bowel appeared normal. Hirschsprung's diseases, necrotizing enterocolitis, small left colon syndrome, atresia, imperforate anus, cystic fibrosis are some causes of colonic perforation in neonates. However none of the clinical features or intra-operative finding of the above conditions could be found in our case. At follow-up, the baby showed normal weight gain without any symptoms.
Abstract:Objectives: Some earlier studies has highlighted the analgesic potentiating effects of intrathecal fentanyl hydrochloride while some recent studies have focused on the effects of decreasing post operative nausea and vomiting . Hence, the current study was planned on comparing the effects of intrathecal fentanyl and intravenous ondansetron in reducing the perioperative nausea and vomiting. Materials and methods: In this randomized prospective study, 140 patients (ASA I&II, aged 18-35 years ) undergoing elective caesarean section were divided into two equal groups (n=70) to receive either intrathecal 20 microgram (0.4ml) with 2.2 ml bupivacaine 0.5% heavy plus 2 ml normal saline intravenously (Group F) or 0.4 ml of normal saline with equal amount of bupivacaine 0.5 % heavy plus 4 mg (2 ml) of ondansetron intravenously (Group O) to compare their effects on perioperative nausea and vomiting . Results: The incidences of intraoperative nausea (12.8% vs 7.15%), vomiting (8.58% vs 4.28%) and retching (8.58% vs 4.28%) were higher in the ondansetron group compared with the fentanyl group and statistically not significant(nausea , P=0.26;vomiting ,P=0.30 and retching , P=0.30). However, the incidence of postoperative nausea , vomiting and retching were higher in the fentanyl group (7.15% vs 2. 86%,P=0.25; 4.28vs2.86,P=0.65 and 4.28vs2.86,P=0.65) respectively. Intraoperative and postoperative hemodynamic parameters were comparable in the two groups(P>0.05).
Conclusion:Although not statistically significant , the incidences of nausea , vomiting and retching were higher in the ondansetron group intraopertively and the same being higher in the fentanyl group postopertively.
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