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Ischemia-reperfusion injury in premature neonate
9%
10/114
Telescoping segment of bowel
18%
21/114
Abnormal rotation of the midgut
55%
63/114
Hypertrophy of the pylorus
7%
8/114
Partial absence of ganglion cells in large intestine
10%
11/114
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This child presenting at 2 weeks of age with bilious vomiting, a distended and tender abdomen, and normal vital signs has malrotation of the midgut, which is caused by incomplete rotation of the midgut during embryological development. During normal development of the gastrointestinal tract, the midgut herniates through the umbilical ring. Subsequently, the small intestine rotates 270 degrees in a counterclockwise direction around an axis created by the superior mesenteric artery (illustration A). In malrotation, the 270 degree counterclockwise rotation does not occur, and the small intestines becomes improperly positioned within the abdomen. Figure A shows a barium upper gastrointestinal series showing right-sided jejunal markings of malrotation of the midgut. Incorrect Answers: Answer 1: Ischemia-reperfusion injury may be involved in the pathogenesis of necrotizing enterocolitis in premature neonates. Answer 2: Intussusception involves the telescoping of one segment of bowel into another. Answer 4: Hypertrophy of the pylorus is involved in hypertrophic pyloric stenosis. Answer 5: Hirschprung disease is caused by absence of ganglion cells in large intestine.
3.4
(10)
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