Surgical Problems in the Newborn Flashcards
Surgical problems in the neonate are mainly due to two factors. Name these factors
Prematurity
Congenital abnormality
What is the most common surgical problem found in premature babies?
Necrotising enterocolitis
Baby’s gut hasn’t formed properly
What is necrotising enterocolitis?
Tissues in the intestine become inflamed and start to die, leading to a perforation developing, which allows the contents of the intestine to leak into the abdomen
List symptoms of NEC
Poor feeding
Vomiting bile
Abdominal distension
Blood in stool
List features of NEC on imaging
Air on both sides of bowel Gas under diaphragm Mottled appearance Pneumoperitoneum Portal venous gas
State the 3 main ways the bowel can become obstructed
External pressure
Something in lumen
Something in wall
What is meconium ileus?
A neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium
List symptoms of meconium ileus
Absolute constipation by 48 hours
Bile-stained vomiting
Abdominal distension.
How is meconium ileus diagnosed?
Plain radiograph
Water soluble contrast given rectally
How does meconium ileus appear on XRAY?
Dilated bowel loops proximal to impaction
Tangled bowel distal to impaction
Soap bubble appearance
Absence of meconium in lumen
What is meconium? Within what time frame after birth does a baby usually pass meconium?
First faeces of newborn infant; black tar
First 24 hours
What is Hirschsprung’s disease?
A congenital disorder of the colon in which certain nerve cells, known as ganglion cells, are absent, causing chronic constipation and faeces impaction
What chronic condition typically presents with meconium ileus in 30% of cases?
Cystic fibrosis
What is jejunal atresia?
Congenital anomaly characterised by obliteration of the lumen of the jejunum leading to a high obstruction
List symptoms of jejunal atresia
Abdominal distension Bilious vomiting but good appetite Mild constipation (may be some faeces)
How is jejunal atresia diagnosed?
Plain radiograph
Water soluble lower GI contrast
How does jejunal atresia appear on XRAY?
Triple bubble appearance (duodenum = two bubbles)
Fewer dilated small bowel loops (‘ladder’)
No gas in rectum
State the main neonatal cause of obstruction caused by external pressure of the bowel
Hernia
List clinical signs of obstructive hernias
Absence of groin crease on affected side
Mass in scrotum (due to peritoneal lining not closing)
If an XRAY of a pelvic hernia was taken, how would the appearance compare to a higher obstruction?
Dilated bowel loops (‘ladder’ effect)
More loops as lower obstruction
List management options for hernia
Manual reduction
Emergency surgery if obstruction
What is bile? What is a normal colour of bile?
Breakdown product of billirubin in the liver, stored in the gallbladder and secreted into the jejunum
Usually mossy green, like fairy liquid
What condition must be excluded first when a child presents with green bilious vomiting?
Malrotation
What is malrotation?
A congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis
What other condition does malrotation predispose the neonate to?
Volvulus
What is midgut volvulus?
Twisting of entire midgut along the axis of superior mesenteric artery
Leads to proximal bowel obstruction and ischaemia
List investigations of choice in malrotation and volvulus
Upper GI contrast study
Plain radiography
How is malrotation and volvulus managed?
Emergency surgery and correction
How does malrotation and volvulus appear on imaging?
Double bubble of duodenal obstruction
Loss of C shape of duodenum
Multiple dilated bowel loops
What is the longest fixed point in the belly? What is the significance of this?
Duodojejunal flexure to caecum
Along line, all blood supply to midgut comes from SMA
How does the axis of the superior mesenteric artery change in malrotation?
DJ flexure is lying low and caecum is lying high due to twisting
