Intestinalna opstrukcija u novorođenčadi liječene u Klinici za dječje bolesti Zagreb

master's thesis

• Title (english): Intestinal obstruction in newborns treated at the Children's Hospital Zagreb
• Author: Viktoria Knežević
• Mentor: Stjepan Višnjić (mentor)
• Committee member: Tomislav Meštrović (predsjednik povjerenstva)
• Committee member: Anko Antabak (član povjerenstva)
• Committee member: Stjepan Višnjić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Kongenitalna opstrukcija tankoga crijeva je jedno od najčešćih kirurških stanja u djece koje se obično prezentira u prvih 24 – 48 sati života povraćanjem i distenzijom trbuha. Opstrukcija duodenuma je češća u muške djece, dok kod jejuno – ilealnih opstrukcija nema razlike među spolovima. Sumnja na opstrukciju se može postaviti in utero prenatalnim ultrazvučnim pregledom, a konačna dijagnoza se postavlja po rođenju na osnovu kliničke slike i radioloških pretraga. Klasični radiološki znak duodenalne opstrukcije je tzv. „double – bubble znak“, odnosno znak dvostrukoga balona. Jejuno – ilealne atrezije imaju manje tipične radiološke nalaze. Terapija je kirurška, a operativnom zahvatu se pristupa nakon uspostave hemodinamske i elektrolitne stabilnosti djeteta. Postoperativno se dijete prati po kirurgu i gastroenterologu. Etiologiju bolesti objašnjava nekoliko različitih teorija te su danas najšire prihvaćene teorija izostanka rekanalizacije i vaskularna teorija, a rizični faktori ostaju nepoznati. Cilj ovoga rada je identificirati maternalne komorbiditete kao potencijalne rizične čimbenike za nastanak opstrukcije tankoga crijeva djeteta in utero. Stanja poput dijabetesa i bubrežnih bolesti u majke su dokazana rizičnim čimbenicima za razvoj bolesti i anomalija u djece. Tako je provedeno retrospektivno istraživanje u kojemu je promatrano 22 novorođenčadi liječene u Klinici za dječje bolesti Zagreb zbog kongenitalne intestinalne opstrukcije. Analizirana je dostupna dokumentacija te su izvedeni komorbiditeti majki ove novorođenčadi kao i postojanje urinarnih infekcija za vrijeme trudnoće. Nije pronađeno povezanosti maternalnih komorbiditeta za vrijeme trudnoće s većom učestalosti intestinalnih opstrukcija u novorođenčadi. Urinarne infekcije za vrijeme trudnoće su najčešće viđane u majki čija su djeca rođena s atrezijom duodenuma, dok u majki novorođenčadi s jejuno – ilealnom atrezijom urinarnih infekcija za vrijeme trudnoće nije bilo. Uzročno – posljedična veza urinarnih infekcija majki za vrijeme trudnoće i nastanka opstrukcije nije potvrđena.

Abstract (english)

Congenital obstruction of the small intestine is one of the most common surgical conditions in children, which is usually presented in the first 24 - 48 hours of life with vomiting and abdominal distention. Obstruction of the duodenum is more common in male children, while there is no difference between the sexes in jejuno – ileal obstructions. Obstruction can be suspected in utero by prenatal ultrasound examination, and the diagnosis is confirmed after birth, based on the clinical presentation and radiological examinations. The classic sign of duodenal obstruction is the "double - bubble sign". Jejuno – ileal atresias have less typical radiological findings. Definitive management is surgery, after the establishment of hemodynamic and electrolyte stability of the child. Postoperatively, the child is monitored by a surgeon and a gastroenterologist. The etiology of the disease is explained by several different theories, and today the absence of recanalization and the vascular theory are the commonest, while the risk factors remain unknown. The aim of this paper is to identify maternal comorbidities as potential risk factors for the occurrence of small bowel obstruction in the child in utero. Conditions such as diabetes and mother’s kidney disease have been proven risk factors for the development of diseases and anomalies in children. A retrospective study was conducted in which 22 newborns treated at the Children’s Hospital Zagreb for congenital intestinal obstruction were observed. The available documentation was analyzed and the comorbidities of the mother of these newborns as well as the existence of a urinary infection during pregnancy were derived. No association of maternal comorbidities during pregnancy with a higher frequency of intestinal obstructions in newborns was found. Urinary infections during pregnancy were most often seen in mothers whose children were born with duodenal atresia, while there were no urinary infections during pregnancy in mothers of newborns with jejuno – ileal atresia. The cause-and-effect relationship between the mother's urinary infection during pregnancy and the occurrence of obstruction has not been confirmed.

• Keywords: intestinalna opstrukcija; komorbiditeti; prenatalni ultrazvuk; rizični faktori
• Keywords (english): intestinal obstruction; comorbidities; prenatal ultrasound; risk factors
• Language: croatian
• URN:NBN: urn:nbn:hr:105:022527
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-25 10:46:22