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Neonatal surgical Emergencies - Pediatric · PDF file Bilious Vomiting +/- fail to pass meconium Abdominal Distension +/- Bilious vomiting +/- fail to pass meconium Upper GI Obstruction

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  • Neonatal surgical

    Emergencies

    Dr Prashant Jain

    Sr Consultant Ped. Surgery & Ped Urology

    Dr BLKSS Hospital

  •  Gastro-Intestinal

     Abdominal wall defects

     Respiratory distress

  • Intestinal Obstruction

     Bilious Vomiting

     Abdominal distension

     Failure to pass meconium

  • Neonatal Intestinal Obstruction

    Bilious Vomiting

    +/- fail to pass meconium

    Abdominal Distension

    +/- Bilious vomiting

    +/- fail to pass meconium

    Upper GI Obstruction

     Duodenal Atresia

     Malrotation

     Jejunal/ileal/colonic atresia

     Meconium ileus

     Anorectal malformation

     Hirschsprung’s Disease

    Small or large bowel

  • PASSAGE OF MECONIUM

    • CANNOT RULE OUT OBSTRUCTION

    • CAN PASS EVEN IN CASES OF ATRESIA

  • Causes

     Intestinal atresia

     Malrotation with or without Midgut volvulus

     Meconium ileus

     Meconium Peritonitis

     Ano-Rectal Malformation

     Hirschsprung’s Disease

  • CASE

     Term male child 2.7 Kg

    discharged after delivery

     Passed meconium

     Antenatal history normal

     Presented at day 5 with

    yellowish vomiting

     Admitted and managed

    conservatively

  •  Again presented after 8 days with bilious vomiting

  • MALROTATION WITH MID GUT VOLVULUS

    Exploratory Laparotomy

  • Malrotation is a TRUE SURGICAL EMERGENCY

    • X-Ray

    • Upper GI study

    • USG

  • Normal

     Acute Intestinal Obstruction  Recurrent abdominal pain and vomiting

    Malrotation Volvulus

  • CASE

     Bilious vomiting

     Antenatal scan:

    Polyhydramnios

     Down’s Syndrome

  • Duodenal Atresia

    Double Bubble

  •  Bilious vomiting/aspirates

     Mild upper abdominal

    distension

     Antenatal H/O of

    Polyhydramnios

     D/D: Jejunal Atresia

    Triple Bubble

    CASE

  • • Bilious vomiting/aspirates

    • Progressive abdominal

    distension

    Multiple air fluid level

    Ileal Atresia

    • Ileal atresia

    • NEC

    • Total colonic

    aganglionosis

    • Meconium Ileus

    D/D

    CASE

  • Colonic Atresia

    CASE

  • Intestinal Atresia

  • CASE

    • Abdominal distension

    from birth

    • Antenatal scan: Echogenic

    and dilated bowel

    • X-ray

  • Abdominal distension since birth

     Meconium ileus

     Meconium peritonitis/ascites

     Abdominal lump

     Ascites

  • Meconium Ileus

    • Gastrograffin enema

  • Exploration

  • CASE

     Term male Newborn

     Antenatal scan s/o

    echogenic bowel

     Bilious aspirates &

    not passed meconium

     Abdominal distension

    since birth

  • Meconium Peritonitis

  • Ano-Rectal Malformation

    Vestibular Fistula Anteriorly placed anus

    Bucket Handle deformity

    Anocutaneous Fistula

  • Ano-Rectal Malformation

    Perineal Examination

    Fistula

    Anoplasty or Pull through after 3mths

    No Fistula

    24 hrs

    Cross table Xray

    Colostomy

    Pull through after 3 months

  • Aganglionosis can extend to variable distance

    • Short segment – Classical

    Rectosigmoid (60-70%)

    • Long Segment (15-20%)

    • Total colonic

    aganglionosis (5-10%)

    • Ultrashort segment

    Hirschsprung’s Disease

  • Presentation

    • Characteristically disease of full term newborn

    • History of constipation dating back to newborn

    period

    • 95% of newborns defecate in first 24 hrs

    of life

    • Abdominal distension

    • Poor feeding

    • Failure to thrive

  • Investigations

    • Barium Enema

    • Rectal Biopsy

  • Definitive Pull through

    for Hirschsprung’s Disease

    • Single stage at age 3-6 months

    • Two stage at 6-12 months after

    colostomy

  • Primary Laparoscopic Assisted

    Pull through

  • Respiratory Distress

  • • Day 1, Term 39 wks,

    delivered in Sonepat

    • Antenatal scan:

    Polyhydramnios

    • Respiratory distress

    • Intubated and transferred

    in BLK

    A new born with

    respiratory distress

    CONGENITAL DIAPHRAGMATIC HERNIA

  • Congenital Diaphragmatic Hernia

    Minimal Barotrauma • Conventional Ventilation • High frequency ventilation • ECMO

    Cardio-Pulmonary Stabilisation

    (Pulmonary Hypoplasia + Hypertension)

    Invasive & Noninvasive monitoring

  • Day 1

    • Respiraory acidosis (Ph 7.26/PO2 118/Pco2 47/Hco3 20.1)

    • Assisted control ventilation

    – Fio2 100%

    – PIP/PEEP: 15/5

    • Dopamine and Adrenaline (Mean 50mm Hg)

    • Cardiac Echo: Mild Pulmonary Hypertension

  • Day 2

    • One episode of desaturation

    • Respiratory acidosis

    • Shifted on HFO

    MAP 14

    Fio2 100%

    Delta P 30

    • Stable

  • Day 3

    • Desaturated

    • Rt Pneumothorax- Drained

    • Stable

  • Day 4(CDH Repair)

  • Post Operative Course

    • Stable on ventilator (PSV)

    • Had collpase/ consolidation of Rt Lung….managed conservatively

    • Extubated on POD 9

    • Discharged on POD 13

    • Asymptomatic now at 3 months

  • A new born with respiratory distress

    Cystic adenomatoid malformation

  • Air filled cystic spaces: Congenital Cystic Adenomatoid Malformation

  • Respiratory distress

    CONGENITAL LOBAR EMPHYSEMA

  • CDH CCAM Pneumatocoel

  • pneumothorax

    CLE CLE