Neonatal surgical

Emergencies

Dr Prashant Jain
Sr Consultant
Ped. Surgery & Ped Urology
Dr BLKSS Hospital
 Gastro-Intestinal
 Abdominal wall defects
 Respiratory distress
 Intestinal Obstruction

 Bilious Vomiting
 Abdominal distension
 Failure to pass meconium
 Neonatal Intestinal Obstruction
Abdominal Distension
Bilious Vomiting +/- Bilious vomiting
+/- fail to pass meconium +/- fail to pass meconium

Upper GI Obstruction Small or large bowel

 Duodenal Atresia  Jejunal/ileal/colonic atresia

 Malrotation  Meconium ileus
 Anorectal malformation
 Hirschsprung’s Disease
 PASSAGE OF MECONIUM

• CANNOT RULE OUT OBSTRUCTION

• CAN PASS EVEN IN CASES OF ATRESIA

 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
 Again presented after 8 days with bilious vomiting
Exploratory Laparotomy

MALROTATION WITH MID GUT VOLVULUS

Malrotation is a TRUE SURGICAL EMERGENCY

• X-Ray
• Upper GI study
• USG
Normal Malrotation Volvulus

 Acute Intestinal Obstruction

 Recurrent abdominal pain and vomiting
 CASE

 Bilious vomiting
 Antenatal scan:
Polyhydramnios
 Down’s Syndrome
 Duodenal Atresia

Double Bubble
 CASE
 Bilious vomiting/aspirates
 Mild upper abdominal
distension
 Antenatal H/O of
Triple Bubble
Polyhydramnios
 D/D: Jejunal Atresia
 CASE Multiple air fluid level

• Bilious vomiting/aspirates
• Progressive abdominal
distension

D/D

• Ileal atresia
• NEC
• Total colonic
aganglionosis
• Meconium Ileus Ileal Atresia
CASE

Colonic Atresia
Intestinal Atresia
 CASE

• Abdominal distension
from birth

• Antenatal scan: Echogenic

and dilated bowel

• X-ray
 Abdominal distension since birth

 Meconium ileus
 Meconium peritonitis/ascites
 Abdominal lump
 Ascites
 Meconium Ileus
• Gastrograffin enema
Exploration
 CASE
 Term male Newborn

 Antenatal scan s/o

echogenic bowel

 Bilious aspirates &

not passed meconium

 Abdominal distension
since birth
Meconium Peritonitis
Ano-Rectal Malformation

Vestibular Fistula
Anteriorly placed anus

Bucket Handle deformity

Anocutaneous Fistula
Ano-Rectal Malformation
Perineal Examination

Fistula No Fistula

24 hrs
Anoplasty or
Cross table Xray
Pull through after
3mths
Colostomy

Pull through after 3 months

 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
 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
 Investigations

• Barium Enema

• Rectal Biopsy
 Definitive Pull through
for Hirschsprung’s Disease

• Single stage at age 3-6 months

• Two stage at 6-12 months after

colostomy
Primary Laparoscopic Assisted
Pull through
Respiratory Distress
 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

Congenital Diaphragmatic Hernia
Cardio-Pulmonary Stabilisation
(Pulmonary Hypoplasia + Hypertension)

Minimal Barotrauma
• Conventional Ventilation
• High frequency ventilation
• ECMO

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
 Day 3

• Desaturated

• Rt Pneumothorax- Drained

• Stable
Day 4(CDH Repair)
 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
A new born with
respiratory distress

Cystic adenomatoid malformation

 Air filled cystic spaces:
Congenital Cystic Adenomatoid Malformation
Respiratory distress

CONGENITAL LOBAR EMPHYSEMA

CDH CCAM Pneumatocoel
CLE CLE

pneumothorax