2: Surgical problems in newborns

Question 1

Surgical problems in newborns often affect which system?

Answer 1

Gastrointestinal system

Question 2

What are the two main causes of surgical GI problems in newborns?

Answer 2

Pre-term birth

Congenital malformations

Question 3

What is pneumoperitoneum?

Answer 3

Free gas within the peritoneal cavity

Question 4

What event precedes most cases of pneumoperitoneum?

Answer 4

Bowel perforation

Question 5

Apart from bowel perforation, what are some other causes of pneumoperitoneum?

Answer 5

Mechanical ventilation

Pneumothorax, pneumomediastinum

Post-operative free air

Oral sex

Question 6

What disease most commonly causes bowel perforation in pre-term babies?

Answer 6

Necrotising enterocolitis (NEC)

Question 7

In which population is necrotising enterocolitis most commonly encountered?

Answer 7

Pre-term babies

Question 8

What is the pathophysiology of NEC?

Answer 8

Idiopathic inflammation, ischaemia and perforation of the bowels

Question 9

What are the symptoms of NEC in a pre-term baby?

Answer 9

Poor feeding

Bile-stained vomiting

Abdominal distension

Bloody stools

Diarrhoea

Question 10

What are the signs of NEC on an abdominal X-ray?

Answer 10

Dilated bowel loops

Pneumoperitoneum

Question 11

What are the three general types of bowel obstruction?

Answer 11

1. Intralumenal obstruction

2. Obstruction caused by the bowel wall itself

3. Compression of bowel from outside structures

Question 12

What area of the small bowel is characteristically affected in Crohn’s disease?

Answer 12

Distal ileum

Question 13

What is meconium?

What does it look like?

Answer 13

First stool passed by a foetus

Usually dark, black and thick in appearance

Question 14

Which disease causes abnormally thickened secretions?

Answer 14

Cystic fibrosis

Question 15

In cystic fibrosis, a baby’s meconium will be (thicker / thinner) than usual.

Answer 15

thicker

Question 16

If a baby has cystic fibrosis, their meconium may be thicker than usual.

Where can it become stuck?

Which kind of obstruction does this cause?

Answer 16

Distal ileum - meconium ileus

Intralumenal obstruction

Question 17

What are the signs and symptoms of meconium ileus?

Answer 17

Bile-stained vomiting

Abdominal distension

Failure to pass first stool by 2 days post-birth

Question 18

Which investigation can be used to diagnose meconium ileus?

Answer 18

Abdominal X-ray with contrast enema

Question 19

What is the appearance of meconium ileus on an abdominal X-ray with contrast enema?

Answer 19

Dense from rectum to distal ileum

Bubbly, patchy lucent appearance from there on - indicates meconium build-up

Question 20

Which type of contrast is used in the diagnosis of meconium ileus?

Answer 20

Water-soluble contrast

Question 21

How meconium ileus treated?

Answer 21

Water-soluble contrast enema usually clears the blockage out

Otherwise surgery

Question 22

What congenital bowel wall problem may cause bowel obstruction in newborns?

Answer 22

Atresia

Duodenal, jejunal, ileal, colonic…

Question 23

What is atresia?

Answer 23

Incomplete formation of a structure

In this case the bowel wall, causing incomplete or complete blockage if the tube is blind-ended

Question 24

What problem, in which an organ protrudes somewhere it shouldn’t, can cause bowel obstruction?

Answer 24

Herniation

inguinal/femoral bowel herniation, leading to compression, ischaemia and perforation

Question 25

Which condition must you exclude in any newborn with bile-stained vomiting?

Answer 25

Malrotation / Volvulus

Question 26

Why must malrotation or volvulus be excluded in any newborn with bile-stained vomiting?

Answer 26

Ischaemia –> Necrosis –> Loss of huge length of small bowel

Question 27

Which investigation can identify malrotation?

Answer 27

X-ray with contrast swallow

Question 28

If you want a contrast swallow for a baby with suspected malrotation, what should you ask the radiographers for specifically?

Answer 28

Abdominal X-ray with water-soluble contrast swallow AND follow through

Question 29

What surgical emergency should you suspect if a baby’s stool is “jelly-like”or“hard and sausage-shaped”?

Answer 29

Intussusception

telescoping of the bowel, causing ischaemia and necrosis