# Bowel Obstruction — GCMD Library living collection

Everything in the library about bowel obstruction — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 70 cited statements

## Episodes
### Surgical Management
- [Laparoscopic Jejunal Atresia Repair - Technique](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748) — video · 5:55 · [machine version](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748.md)
- [Laparoscopic Jejunal Atresia Repair - Technique](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751) — video · 5:55 · [machine version](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751.md)

### Evidence & Research
- [Dr. Alicia Greene - Best of the Best in Pediatric Surgery 2025](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035) — video · 7:42 · [machine version](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=0) Case presentation and patient positioning (Ep 1)
- [1:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=90) Port placement and initial exploration (Ep 1)
- [3:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=180) Bowel examination and apple peel defect confirmation (Ep 1)
- [4:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=240) Resection of dilated proximal segment (Ep 1)
- [5:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=300) Anastomosis creation and procedure completion (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=0) Case presentation and operative setup (Ep 2)
- [1:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=90) Initial exploration and identification of apple peel defect (Ep 2)
- [3:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=180) Resection of dilated proximal segment (Ep 2)
- [4:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=270) Anastomosis creation and closure (Ep 2)
- [5:40](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=340) Postoperative course and outcomes (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=0) Introduction to presentation session (Ep 3)
- [0:23](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=23) Background on SAP bead ingestion problem (Ep 3)
- [2:00](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=120) Study methodology (Ep 3)
- [3:20](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=200) Literature review findings (Ep 3)
- [4:40](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=280) In vitro experiment results and conclusions (Ep 3)
- [5:28](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=328) Discussion and advocacy efforts (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- A newborn with prenatal diagnosis of bowel obstruction was found to have jejunal atresia on upper GI study (clinical) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=0)
- The surgeon stands at the baby's feet with the cameraman on the baby's right and the scrub tech on the patient's left for this procedure (clinical) [Ep 1 · 0:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=30)
- A 3-port technique was used with a 4 mm 30-degree scope for visualization and two 3 mm ports for dissection (clinical) [Ep 1 · 0:50](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=50)
- The left mid-quadrant port was later changed to a 5 mm port for the stapler (clinical) [Ep 1 · 1:10](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=70)
- The Veress needle is inserted below the umbilicus to avoid injury to the umbilical vessels and prevent CO2 embolism (clinical) [Ep 1 · 1:20](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=80)
- There was a complete gap between the proximal jejunum and the distal bowel, with visualization of appendix and cecum suggesting an apple peel defect (clinical) [Ep 1 · 2:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=120)
- The bowel was run from proximal to distal to ensure there were no other areas of obstruction or kinking (clinical) [Ep 1 · 2:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=150)
- Running the bowel distally confirmed an apple peel defect, as the bowel could be seen twisting around the mesentery (clinical) [Ep 1 · 2:50](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=170)
- Because there was no evidence of a kink or significant obstruction, the mesentery was not further manipulated (clinical) [Ep 1 · 3:10](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=190)
- A decision was made to remove the proximal dilated segment in the hopes of improving bowel motility following surgery, because it was relatively short and significantly dilated (clinical) [Ep 1 · 3:40](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=220)
- The mesentery is taken down using a 3 mm bipolar vessel sealer, with vessels clamped, sealed, and then teased off the mesenteric border of the bowel (clinical) [Ep 1 · 4:10](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=250)
- The dissection was carried back almost to the ligament of Treitz and encompassed approximately 10 cm length of bowel (clinical) [Ep 1 · 4:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=270)
- A 5 mm endoscopic stapler was used to divide the bowel, laying down 4 rows of staples and dividing between them (clinical) [Ep 1 · 4:50](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=290)
- Two applications of the stapler were required because the bowel was so dilated, with a diameter of almost 4 cm (clinical) [Ep 1 · 5:10](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=310)
- The distal jejunal segment was anastomosed to the proximal dilated segment in an end-to-side fashion (clinical) [Ep 1 · 5:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=330)
- An enterotomy was made in the proximal dilated bowel using a 3 mm hook cautery and then decompressed with a 3 mm sucker (clinical) [Ep 1 · 5:45](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=345)
- A similar enterotomy was made in the distal jejunal segment and slightly dilated to allow access of the stapler (clinical) [Ep 1 · 6:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=360)
- The anastomosis was approximately 2.5 cm in length (clinical) [Ep 1 · 6:15](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=375)
- The resultant enterotomy was closed with a running absorbable suture (clinical) [Ep 1 · 6:25](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=385)
- Previous to having the stapler, an end-to-end anastomosis would have been performed with multiple interrupted or running sutures (clinical) [Ep 1 · 6:35](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=395)
- After completion of the enterotomy, there was no evidence of significant mesenteric defect or any gap in the anatomy (clinical) [Ep 1 · 6:50](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=410)
- The procedure took 80 minutes and was tolerated well by the infant (clinical) [Ep 1 · 7:05](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=425)
- The patient had diminishing NG aspirates over the next week (clinical) [Ep 1 · 7:20](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=440)
- An upper GI obtained one week postoperatively showed a widely patent anastomosis (clinical) [Ep 1 · 5:55](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=355)
- The resected specimen measured 10 cm (clinical) [Ep 1 · 5:55](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=355)
- Newborn had prenatal diagnosis of bowel obstruction and was found to have jejunal atresia on upper GI study (clinical) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=0)
- Surgeon stands at baby's feet with cameraman on baby's right and scrub tech on patient's left (clinical) [Ep 2 · 0:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=30)
- 3-port technique used with 4mm 30-degree scope for visualization and two 3mm ports for dissection (clinical) [Ep 2 · 0:50](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=50)
- Left mid quadrant port was later changed to 5mm for the stapler (clinical) [Ep 2 · 1:10](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=70)
- Veress needle is inserted below the umbilicus to avoid injury to umbilical vessels and prevent CO2 embolism (clinical) [Ep 2 · 1:20](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=80)
- Complete gap identified between proximal jejunum and distal bowel (clinical) [Ep 2 · 2:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=120)
- Visualization of appendix and cecum suggests apple peel defect (clinical) [Ep 2 · 2:20](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=140)
- Bowel twisting around mesentery confirmed apple peel defect (clinical) [Ep 2 · 2:40](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=160)
- Because there was no evidence of kink or significant obstruction, mesentery was not further manipulated (clinical) [Ep 2 · 3:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=180)
- Decision made to remove proximal dilated segment to improve bowel motility following surgery because it was relatively short and significantly dilated (clinical) [Ep 2 · 3:20](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=200)
- 3mm bipolar vessel sealer used to take down mesentery by clamping, sealing, and teasing vessels off mesenteric border of bowel (clinical) [Ep 2 · 3:50](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=230)
- Dissection carried back almost to ligament of Treitz and encompassed approximately 10 cm length of bowel (clinical) [Ep 2 · 4:10](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=250)
- 5mm endoscopic stapler lays down 4 rows of staples and divides between them (clinical) [Ep 2 · 4:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=270)
- Two applications of stapler required because bowel was so dilated with diameter almost 4 cm (clinical) [Ep 2 · 4:45](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=285)
- Distal jejunal segment anastomosed to proximal dilated segment in end-to-side fashion (clinical) [Ep 2 · 5:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=300)
- Enterotomy made in proximal dilated bowel using 3mm hook cautery and decompressed with 3mm sucker (clinical) [Ep 2 · 5:15](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=315)
- Distal jejunal segment enterotomy slightly dilated to allow access of stapler (clinical) [Ep 2 · 5:30](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=330)
- End-to-side anastomosis approximately 2.5 cm in length performed without difficulty (clinical) [Ep 2 · 5:40](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=340)
- Resultant enterotomy closed with running bioabsorbable suture (clinical) [Ep 2 · 5:55](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=355)
- Previous to having stapler, would have performed end-to-end anastomosis with multiple interrupted or running sutures (clinical) [Ep 2 · 6:05](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=365)
- No evidence of significant mesenteric defect or gap in anatomy after enterotomy completion (clinical) [Ep 2 · 6:20](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=380)
- Procedure took 80 minutes and was tolerated well by infant (clinical) [Ep 2 · 6:35](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=395)
- Patient had diminishing NG aspirates over next week (clinical) [Ep 2 · 6:50](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=410)
- Upper GI obtained one week postoperatively showed widely patent anastomosis (clinical) [Ep 2 · 7:00](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=420)
- Resected specimen measured 10 cm (clinical) [Ep 2 · 7:15](https://origin-library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=435)
- The number of SAP bead ingestion cases has significantly increased over the last decade. — Alicia Green (epidemiological) [Ep 3 · 3:20](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=200)
- From 87 cases identified in literature review, the average patient age was 14 months. — Alicia Green (epidemiological) [Ep 3 · 3:20](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=200)
- Only 16% of patients had a witnessed ingestion of the foreign body. — Alicia Green (epidemiological) [Ep 3 · 3:35](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=215)
- Abdominal X-rays were performed in 74% of cases, but only 6% commented on a visualized foreign body. — Alicia Green (clinical) [Ep 3 · 3:40](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=220)
- Ultrasound performed in 57% of cases successfully visualized a foreign body in 86% of instances. — Alicia Green (clinical) [Ep 3 · 3:50](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=230)
- Definitive retrieval of the beads was achieved with surgery in 84% of cases and endoscopy in 8% of cases. — Alicia Green (clinical) [Ep 3 · 4:00](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=240)
- The mean bead size at retrieval was 33.7 millimeters. — Alicia Green (clinical) [Ep 3 · 4:10](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=250)
- Post-operative complications occurred in about 19% of cases, the majority of which were reoperations to remove additional beads not identified in the initial procedure. — Alicia Green (clinical) [Ep 3 · 4:15](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=255)
- Two patients experienced an anastomotic leak requiring an ileostomy. — Alicia Green (clinical) [Ep 3 · 4:30](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=270)
- The median hospital length of stay was six days and one mortality was recorded. — Alicia Green (clinical) [Ep 3 · 4:35](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=275)
- The maximum rate of growth was observed in the first hour for the small and medium beads and between hours 1 and 3 for the large beads in the in vitro experiment. — Alicia Green (clinical) [Ep 3 · 4:40](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=280)
- The medium beads had the greatest growth rate at 305% in simulated small bowel fluid. — Alicia Green (clinical) [Ep 3 · 4:55](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=295)
- Small beads only reached a maximum diameter of less than 1 centimeter, which was not thought to be clinically significant to result in a small bowel obstruction. — Alicia Green (opinion) [Ep 3 · 5:00](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=300)
- The greatest reduction in bead size after 24 hours was noted in beads exposed to GoLYTELY with almost a 40% size reduction, followed by prune juice, Gastrografin and 10% acetylcysteine. — Alicia Green (clinical) [Ep 3 · 5:10](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=310)
- During surgery, a thorough examination of the entire bowel and a high index of suspicion for multiple beads is essential. — Alicia Green (guideline) [Ep 3 · 5:20](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=320)
- Hyperosmolar solutions and osmotic laxatives may have the potential to reduce the size of SAP beads if ingested by children. — Alicia Green (opinion) [Ep 3 · 5:20](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=320)
- The research group was invited by the AAP and APSA advocacy group to share findings and meet with representatives from national recall companies to develop a plan to recall certain products. — Alicia Green (clinical) [Ep 3 · 6:18](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=378)
- Larger beads don't seem to be produced as much but seem to be causing the majority of the problems. — Alicia Green (opinion) [Ep 3 · 6:50](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=410)
- Endoscopic retrieval could only reach beads mainly in the duodenum, maybe proximal jejunum. — Alicia Green (clinical) [Ep 3 · 7:00](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=420)
- Most endoscopic retrievals used a basket but some were able to crush up the beads into small pieces and then allow them to pass on their own. — Alicia Green (clinical) [Ep 3 · 7:20](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=440)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Studies have found that breaking up the beads will sometimes allow them to be passed on their own. — Alicia Green summarizing a resource [Ep 3 · 7:10](https://origin-library.globalcastmd.com/watch/dr-alicia-greene-best-of-the-best-in-pediatric-surgery-2025-10035?t=430)

## Changelog
- Sep 25: 3 items added automatically

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