Neonatal Surgical Problems Flashcards
List 6 common surgical problems in neonates
- Jejunal atresia
- Duodenal atresia
- Malrotation + volvulus
- Meconium ileus
- Inguinal hernia
- Necrotising enterocolitis
What is necrotising enterocolitis?
Inflammation and death of the intestine walls, which can lead to perforation of the bowel walls
What radiological signs may be seen in necrotising enterocolitis?
- Distended abdomen
- Distended, dark, air-filled bowel loops
- Air in the abdomen = perforated bowel
Necrotising enterocolitis is congenital/acquired?
Acquired
What is meconium ileus?
Bowel obstruction caused by meconium (1st poo) which is thicker than it should be and has become stuck in the ileum
What condition often presents as meconium ileus in newborns and why?
Cystic fibrosis
Lack of mucus means that meconium is not passed
What features of meconium ileus can be seen on x-ray with contrast?
- Distended abdomen
- Upstream bowel is distended and full of air
- Distal bowel is thin and unused
What is duodenal atresia and what congenital condition is it often seen with?
Absence or complete narrowing of a portion of the duodenum, resulting in blockage
Often seen in Down’s syndrome
What are the radiological features of duodenal atresia?
- Distended abdomen
- Distended, air-filled duodenum upstream to the area of atresia
- Distal bowel is small and unused
What is jejunal atresia?
Complete obstruction of a portion of the jejunum of the small intestine
What are the radiological features of jejunal atresia?
- Distended abdomen
- Distended, air-filled bowel upstream to the area of atresia (so will have more distended bowel when compared to duodenal atresia)
- Distal bowel is small and unused
What is an inguinal hernia?
A protrusion of abdominal organs through a weakness in the abdominal wall in the inguinal (groin) region
How can an inguinal hernia appear on xray?
- Extensive distended bowel loops as obstruction in very low down in the bowel
- A loop of bowel seen sitting too low - this is the part of bowel which has protruded out of the abdominal wall
Vomiting of green bile is which condition until proven otherwise?
Malrotation + volvulus
What is malrotation and volvulus?
Malrotation: incomplete rotation of the bowel during foetal development
Volvulus: a complication of malrotation where the bowel becomes twisted and the blood supply is cut off
Where are the 2 normal fixed points of the bowel and where do they move to in malrotation?
1: Where the duodenum becomes the jejunum
2. At the appendix
In malrotation, the 1st fixed point is lower and to the right
The 2nd fixed point is higher and found next to the displaced 1st point
What is the investigation of choice for malrotation and volvulus?
Upper GI contrast with follow through
What are the radiological features of malrotation and volvulus?
- NG tube inserting contrast into stomach, then into duodenum until point of twisting
- Spiral is seen in duodenum at point of twisting
- No contrast carried on past the twisting
Why is malrotation and volvulus a lifethreatening condition?
Bowel twisting blocks the superior mesenteric artery, cutting off blood supply to the midgut
How is a volvulus fixed in surgery?
The bowel is untwisted and put back in the abdomen in a safe place do that adhesions form and prevent re-twisting
What happens if malrotation and volvulus is caught too late?
The bowel dies and the baby cannot be saved
this is why green bile is a red flag!
Which of these conditions can cause perforation of the bowel?
- Jejunal atresia
- Duodenal atresia
- Malrotation + volvulus
- Meconium ileus
- Inguinal hernia
- Necrotising enterocolitis
Necrotising enterocolitis
Which of these conditions is due to obstruction inside the lumen of the bowel?
- Jejunal atresia
- Duodenal atresia
- Malrotation + volvulus
- Meconium ileus
- Inguinal hernia
- Necrotising enterocolitis
Meconium ileus
Which of these conditions is due to obstruction in the wall of the bowel?
- Jejunal atresia
- Duodenal atresia
- Malrotation + volvulus
- Meconium ileus
- Inguinal hernia
- Necrotising enterocolitis
Duodenal atresia
Jejunal atresia
Which of these conditions is due to obstruction outside the wall of the bowel?
- Jejunal atresia
- Duodenal atresia
- Malrotation + volvulus
- Meconium ileus
- Inguinal hernia
- Necrotising enterocolitis
Malrotation + volvulus
Inguinal hernia
