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Newborn surgical-emergencies

Pediatric surgery is a sub speciality of surgery pertaining to patients ranging from new-borns to 18 years of age. It comes with its own challenges that differentiate it from other surgeries. Whether it is the small size of babies and children to be operated or dealing with their responses to illness or surgery, every aspect of Pediatric Surgery needs special attention. Hence, there is a rationale for a dedicated division for Paediatric Surgery.

DrPrashantJain
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Newborn surgical-emergencies

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  1. Neonatal surgical Emergencies Dr Prashant Jain Sr Consultant Ped. Surgery & Ped Urology Dr BLKSS Hospital

  2.  Gastro-Intestinal  Abdominal wall defects  Respiratory distress

  3. Intestinal Obstruction  Bilious Vomiting  Abdominal distension  Failure to pass meconium

  4. Neonatal Intestinal Obstruction Abdominal Distension +/- Bilious vomiting +/- fail to pass meconium Bilious Vomiting +/- fail to pass meconium Upper GI Obstruction Small or large bowel  Jejunal/ileal/colonic atresia  Meconium ileus  Anorectal malformation  Hirschsprung’s Disease  Duodenal Atresia  Malrotation

  5. PASSAGE OF MECONIUM • CANNOT RULE OUT OBSTRUCTION • CAN PASS EVEN IN CASES OF ATRESIA

  6. Causes  Intestinal atresia  Malrotation with or without Midgut volvulus  Meconium ileus  Meconium Peritonitis  Ano-Rectal Malformation  Hirschsprung’s Disease

  7. 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

  8.  Again presented after 8 days with bilious vomiting

  9. Exploratory Laparotomy MALROTATION WITH MID GUT VOLVULUS

  10. Malrotation is a TRUE SURGICAL EMERGENCY • X-Ray • Upper GI study • USG

  11. Volvulus Malrotation Normal  Acute Intestinal Obstruction  Recurrent abdominal pain and vomiting

  12. CASE  Bilious vomiting  Antenatal scan: Polyhydramnios  Down’s Syndrome

  13. Duodenal Atresia Double Bubble

  14. CASE  Bilious vomiting/aspirates  Mild upper abdominal distension  Antenatal H/O of Polyhydramnios Triple Bubble  D/D: Jejunal Atresia

  15. CASE Multiple air fluid level • Bilious vomiting/aspirates • Progressive abdominal distension D/D • Ileal atresia • NEC • Total colonic aganglionosis • Meconium Ileus Ileal Atresia

  16. CASE Colonic Atresia

  17. Intestinal Atresia

  18. CASE • Abdominal distension from birth • Antenatal scan: Echogenic and dilated bowel • X-ray

  19. Abdominal distension since birth  Meconium ileus  Meconium peritonitis/ascites  Abdominal lump  Ascites

  20. Meconium Ileus • Gastrograffin enema

  21. Exploration

  22. CASE  Term male Newborn  Antenatal scan s/o echogenic bowel  Bilious aspirates & not passed meconium  Abdominal distension since birth

  23. Meconium Peritonitis

  24. Ano-Rectal Malformation Vestibular Fistula Anteriorly placed anus Bucket Handle deformity Anocutaneous Fistula

  25. Ano-Rectal Malformation Perineal Examination No Fistula Fistula 24 hrs Anoplasty or Pull through after 3mths Cross table Xray Colostomy Pull through after 3 months

  26. Hirschsprung’s Disease Aganglionosis can extend to variable distance • Short segment – Classical Rectosigmoid (60-70%) • Long Segment (15-20%) • Total colonic aganglionosis (5-10%) • Ultrashort segment

  27. 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

  28. Investigations • Barium Enema • Rectal Biopsy

  29. Definitive Pull through for Hirschsprung’s Disease • Single stage at age 3-6 months • Two stage at 6-12 months after colostomy

  30. Primary Laparoscopic Assisted Pull through

  31. Respiratory Distress

  32. A new born with respiratory distress • Day 1, Term 39 wks, delivered in Sonepat • Antenatal scan: Polyhydramnios • Respiratory distress • Intubated and transferred in BLK CONGENITAL DIAPHRAGMATIC HERNIA

  33. Congenital Diaphragmatic Hernia Cardio-Pulmonary Stabilisation (Pulmonary Hypoplasia + Hypertension) Minimal Barotrauma • Conventional Ventilation • High frequency ventilation • ECMO Invasive & Noninvasive monitoring

  34. 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

  35. Day 2 • One episode of desaturation • Respiratory acidosis • Shifted on HFO MAP 14 Fio2 100% Delta P 30 • Stable

  36. Day 3 • Desaturated • Rt Pneumothorax- Drained • Stable

  37. Day 4(CDH Repair)

  38. 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

  39. A new born with respiratory distress Cystic adenomatoid malformation

  40. Air filled cystic spaces: Congenital Cystic Adenomatoid Malformation

  41. Respiratory distress CONGENITAL LOBAR EMPHYSEMA

  42. CCAM Pneumatocoel CDH

  43. CLE CLE pneumothorax

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