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Emergency for every doctor

January 2018

Surgical Emergencies in Pediatric

IGB Adria Hariastawa

Div Bedah Anak, Dep/SMF Bedah

RSUD. Dr Soetomo/FK Unair

Suarabaya
The previously high mortality of neonatal anatomy anomaly
especially gastrointestinal obstruction has been reduce by
perinatal diagnosis of pathology, improved pediatric intensive
care, safer anaesthesia and refined surgical techniques.

Neonatal gastrointestinal obstruction is one of the most


common surgical emergencies in the neonatal period
The diagnosis must be established as early as possible to
prevent clinical deterioration, aspiration pneumonia, sepsis and
biochemical and haemotological derangements.
Neonatal surgery is usually performed to correct life
threatening congenital abnormalities

Such abnormalities are frequently multiple, and co-existing


defect may have considerable anaesthetic and surgery
implication

Neonates may have respiratory, cardiac or neurological disorder


 ANTENATAL DIAGNOSIS OF PEDIATRIC SURGICAL ANOMALI

 Diagnosis and management of fetal malformations

 Family history, Polyhydramnios

 Increased or decreased of maternal serum Alpha Feto


Protein

 The great majority of antenatal diagnosis are now made


during routine ultrasound screening of fetal anatomy, usually
carried out at 19-20 weeks gestation
Important to note postnatal
disorder

-Associated anomali
- Trisomy 21
- Bilious emesis
- Abdominal distention
- Delayed meconium passage
-- Metabolic disorders
Esophageal Atresia

• Antenatal dianosis by USG examination was first made in


1980.
• The diagnosis should be considered in any neonate with a
history of polyhydramnios in pregnancy
• There is excess frothy saliva or cyanotic episodes,
especially when associated feeding
Duodenal Obstruction

 Prenatal diagnosis is based on the demonstration of


caracteristic double-bubble, can be seen as early as 20 weeks
gestation.

 When a neonate develops bilious vomiting, a surgical


condition should be suspected.

 Proximal obstructions produce epigastric distension


 Jejunoileal atresia
 caused by late intrauterin mesenteric vascular accidents such
as volvulus, intussusception, internal hernia, and bowel
incarceration in an omphalocele or gastroschisis.

 The late occurrence of such events account for the relatively


low incident of associated anomalies.
 GASTROSCHISIS

 There is a round full-thickness defect of the anterior


abdominal wall. The defect is usually small, having a
diameter of few centimeters, and located between the
rectus muscles, albeit usually to the right of umbilical cord.
VU

Umbilikus
 EXOMPHALOS

 There is an anterior midline defect of the abdominal


wall through which various viscera herniate into an
avascular hernial sac. The sac consists of peritoneum
on the inside, amniotic mambrane on the outside and a
thin layer of Wharton’s jelly in between
Congenital Diaphragmatic Hernia

• The lung hypoplasia is phenomenon of intrathoracic


abdominal visceral herniation, and the associated
pulmonary hypertension continue to evade attempts by
postnatal intervention to reduce their frequently
catasthrophic consequences on neonatal survival
Congenital Anorectal Anomalies
Intussuception
 Most commonly between the age of two months and two
years

 Trias intussuception : 1. Colicky abdominal pain

2. Sausage-shaped mass

3. Blood and mucus perrectum

(redcurrant jelly stool)