Common Surgical Problems in the Neonate Flashcards
What are the most common surgical problems in a neonate?
- Meconium Ileus
- Malrotation
- Jejunal Atresia
- Inguinal Hernia
- Necrotising Enterocolitis
Why do newborn babies get sick?
- premature babies
- Babies born with a congenital “something”
How can prematurity cause problems in the bowel?
- bowel wall not sturdy enough to be used at preterm age
=> often perforate and release gas
HOw can a bowel perforation due to prematurity be identified on a neonatal abdominal XRay?
- outlined liver (due to gas around it)
- Bubbles of gas in pelvis (bowel herniation)
- Portal gas in biliary tree
- train track bowel wall => gas on both sides
What condition in neonates is characterised by perforation on XRay?
Necrotising Enterocolitis
How are babies with Necrotising Enterocolitis fed?
- Special feeds (mother’s milk is best)
- can use NG or IV feeds
How does an obstruction in newborns occur and how is it identified?
- due to congenital abnormality
- problem with feeding normally identified
Where can a blockage occur in neonates?
- in the lumen
- in wall of bowel
- outside of bowel
A baby is keen to feed, yet by 48 hours shows signs of bilious vomiting and is bringing their feed back up.
They have yet to pass their first bowel movement and their abdomen is distended.
What is the most likely diagnosis?
Meconium Ileus (intralumenal cause) - if not yet passed first bowel movement, then it may be stuck in ileum
What investigations should be considered if there is suspicion of meconium ileus?
- FLuroscopy (contrast used with XRay)
- Lower GI contrast given (=> inserted upwards via rectum)
What can be seen on fluroscopy in Meconium Ileus
- Large bowel (colon) may appear small as it has never been filled
- Large dilated small bowel loops
- Some small contracted bowel
- Patchy appearance of ileum
How is a baby’s tummy described on examination if they have meconium ileus?
- “doughy” on palpation due to distension
What condition is meconium ileus commonly associated with?
- Cystic fibrosis (due to increased secretions)
- 1/3 of babies will present with this and not respiratory problems
How can a fluoroscopy be useful in meconium ileus?
- Contrast fluid can be useful in lubricating bowel to allow meconium to move
What treatment is used for meconium ileus if fluroscopy is NOT successful at moving the meconium?
- Surgery
- Temporary Stoma
Name another intralumenal cause of obstruction
constipation
What causes of obstruction are found in the bowel wall?
- Atresia (usually in small bowel)
=> congenital dead end
How does bowel atresia present after birth?
- 6 hours after birth a baby starts vomiting green.
- Full abdomen
- No bowel movements passed
How does bowel atresia usually appear on XRay?
- distended bowel
- Not many loops of bowel as obstruction is normally high (hence why vomiting starts after 6 hrs or so)
Why would fluoroscopy be useful in investigating for atresia?
checks for meconium in parts of bowel
How is bowel atresia treated?
2 dead ends joined together
Give an example of a condition that could cause bowel obstruction from outside of the wall?
- Hernia (compresses bowel as squeezed into tighter space)
- Malrotation (twisting of bowel on mesentery)
How may an inguinal hernia be identified
- swelling in inguinal area
- asymmetrical groin creases
How can a bowel herniation be identified on Xray?
- gas in wrong place (e.g. in pelvis)
- laddering of loops may be seen on top of each other
What part of herniation can cause bowel ischaemia?
Tight pressure in scrotum with testes
- as have descended in inguinal canal
XRays are not required for a diagnosis of a hernia. TRUE/FALSE?
TRUE
When do children with malrotation usually present?
within 1st month
but can be older
How is malrotation usually investigated?
Upper GI contrast study
Fluoroscopy
How does malrotation appear on XRay?
- stomach distended
- Duodenal-Jejunal flexure is low and medial (rather than high and lateral behind stomach)
- Usually Ileo-caecum -> DJ flexure is largest diameter in abdomen
- Decreasing this diameter allows the mesentery to twist upon itself and cut off blood supply
What blood vessel is compromised if the mesentery twists on itself during a case of malrotation?
Superior Mesenteric Artery (SMA)
How is malrotation surgically treated?
- Division of Ladd’s bands (fibrous stalks of peritoneal tissue that attach caecum to the retroperitoneum)
What diagnosis should be excluded first in a sick newborn?
Malrotation (as bowel may become ischaemic => baby wont survive)
