Surgical problems in the newborn

Question 1

necrotising enterocolitis

• occurs in what group?
• findings on examination? (6)
• associated features? (6)
• Dx?
• management?(3)

Answer 1

-preterm neonates, in first 2 weeks

-Abdominal distension with increasing gastric aspirates.
Visible intestinal loops.
Altered stool pattern.
Bloody mucoid stool and bilious vomiting.
Decreased bowel sounds with erythema of the abdomen.
Palpable abdominal mass or ascites.

• Associated features are bradycardia, lethargy, shock, apnoea, respiratory distress, temperature instability.
• via X-ray

-Intravenous (IV) fluids, total parenteral nutrition (TPN) and IV antibiotics for 10-14 days:
Ampicillin/gentamicin or cefotaxime.
Plus metronidazole or clindamycin.

Question 2

Lumen obstruction

• when should meconium be passed by?
• what is a meconium ileus? treatment?
• what is small bowel atresia, management?

Answer 2

-48 hours

-Meconium gets clogged in the gut, do a contrast enema
need to cut into bowel and milk meconium out, might need to bring out as temporary stoma
associated with CF

-when the small bowel is not connected i.e. just stops, surgically managed after a contrast enema to locate dead end then sew together

Question 3

hernia

• signs?
• management?

Answer 3

see gas in groin on X-ray. laddering appearance
loss of leg creases on the L and a bulge in the scrotum

-emergency, don’t want bowel to get ischeamic, try to reduce non-surgically first

Question 4

Bile green vomit in babies

• indicates what?
• management?

Answer 4

• obstruction outs the lumen: malrotation till proven otherwise!!
• contrast enema from stomach- does it spiral in duodenum? If malrotation then surgically fix