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Neonatal surgical
Emergencies
Dr Prashant Jain
Sr Consultant Ped. Surgery & Ped Urology
Dr BLKSS Hospital
Neonatal Intestinal Obstruction
Bilious Vomiting
+/- fail to pass meconium
Abdominal Distension
+/- Bilious vomiting
+/- fail to pass meconium
Upper GI Obstruction
Duodenal Atresia
Malrotation
Jejunal/ileal/colonic atresia
Meconium ileus
Anorectal malformation
Hirschsprung’s Disease
Small or large bowel
Causes
Intestinal atresia
Malrotation with or without Midgut volvulus
Meconium ileus
Meconium Peritonitis
Ano-Rectal Malformation
Hirschsprung’s Disease
CASE
Term male child 2.7 Kg
discharged after delivery
Passed meconium
Antenatal history normal
Presented at day 5 with
yellowish vomiting
Admitted and managed
conservatively
Bilious vomiting/aspirates
Mild upper abdominal
distension
Antenatal H/O of
Polyhydramnios
D/D: Jejunal Atresia
Triple Bubble
CASE
• Bilious vomiting/aspirates
• Progressive abdominal
distension
Multiple air fluid level
Ileal Atresia
• Ileal atresia
• NEC
• Total colonic
aganglionosis
• Meconium Ileus
D/D
CASE
CASE
Term male Newborn
Antenatal scan s/o
echogenic bowel
Bilious aspirates &
not passed meconium
Abdominal distension
since birth
Ano-Rectal Malformation
Vestibular Fistula Anteriorly placed anus
Bucket Handle deformity
Anocutaneous Fistula
Ano-Rectal Malformation
Perineal Examination
Fistula
Anoplasty or Pull through after 3mths
No Fistula
24 hrs
Cross table Xray
Colostomy
Pull through after 3 months
Aganglionosis can extend to variable distance
• Short segment – Classical
Rectosigmoid (60-70%)
• Long Segment (15-20%)
• Total colonic
aganglionosis (5-10%)
• Ultrashort segment
Hirschsprung’s Disease
Presentation
• Characteristically disease of full term newborn
• History of constipation dating back to newborn
period
• 95% of newborns defecate in first 24 hrs
of life
• Abdominal distension
• Poor feeding
• Failure to thrive
Definitive Pull through
for Hirschsprung’s Disease
• Single stage at age 3-6 months
• Two stage at 6-12 months after
colostomy
• Day 1, Term 39 wks,
delivered in Sonepat
• Antenatal scan:
Polyhydramnios
• Respiratory distress
• Intubated and transferred
in BLK
A new born with
respiratory distress
CONGENITAL DIAPHRAGMATIC HERNIA
Congenital Diaphragmatic Hernia
Minimal Barotrauma • Conventional Ventilation • High frequency ventilation • ECMO
Cardio-Pulmonary Stabilisation
(Pulmonary Hypoplasia + Hypertension)
Invasive & Noninvasive monitoring
Day 1
• Respiraory acidosis (Ph 7.26/PO2 118/Pco2 47/Hco3 20.1)
• Assisted control ventilation
– Fio2 100%
– PIP/PEEP: 15/5
• Dopamine and Adrenaline (Mean 50mm Hg)
• Cardiac Echo: Mild Pulmonary Hypertension
Day 2
• One episode of desaturation
• Respiratory acidosis
• Shifted on HFO
MAP 14
Fio2 100%
Delta P 30
• Stable
Post Operative Course
• Stable on ventilator (PSV)
• Had collpase/ consolidation of Rt Lung….managed conservatively
• Extubated on POD 9
• Discharged on POD 13
• Asymptomatic now at 3 months