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NEONATAL SURGICAL EMERGENCIES

The fetus is dependent on the mother for all its requirements of oxygen, fluid, metabolites and warmth

The neonatal period is the first 28 days of post-delivery life.

The emergencies are related to:


Dehydration- Intestinal obstructions ExposureAnterior abdominal wall defects (Gastroschisis) Dysplastic lungs (CDH)

Hypoxia
Ischaemia-

Midgut volvulus

Perforation- Anorectal malformations

Intestinal obstruction
Dehydration - Unable to feed How to recognize patients Intermittent, persistent vomiting Antenatal dilated bowel loops / Polyhydramnios. Risk of aspiration of vomitus Vomiting Bile is pathognomonic. Increasing abdominal distension No passage of stool Associated congenital anomalies Abdominal X-ray

What is the emergency ?

Duodenal Atresia, Oesophageal Atresia, Fallots Tetralogy Proximal Jejunal Atresia Type IIIb, SGA

Double Bubble

Intestinal obstruction
What is the pathology
Foetus starts with completely patent GIT tube

Management options Developmental & Embolic lesions give rise to gut lesion
Prevent complications. tube & regular aspiration Atresias Vs StenosesN/g & Volvulus. IV Fluids Warmth & Oxygen Make diagnosis Clinically & investigations ICU Surgical treatment Post-Operative care TPN further Surgery Outcome Other anomalies

Gastroschisis
The bowel herniates through the anterior abdominal wall The exposed bowel How to recognize patients Looses heat & fluid neonatal Stress Antenatal diagnosis by ultrasound should be standard. - has become & thick cant Feed. Narrow =Inflammed paraumbilical defect with short protruding bowel loops.
Prone to Trauma & Ischaemia - obstruction Distinguish condition from Exomphalos by the; -bowel lies Rt of & the normal umbilicus Bacterial exposure infection septicaemia. -no covering to the bowel -premature child.

What is the emergency?

Gastroschisis

Gastroschisis
What is the pathology
Theories of causation. th week gestation Involution of vein @ 4-5 Management options Rupture of an exomphalos Antenatal diagnosis & discussion with parents World-wide increase Primary bowel reduction Analgesia Young mothers of +/- 21 years of age. Evacuation of bowel contents Abdominal wall stretch A need for Silo and gradual reduction
Total parenteral nutrition, venous access, sepsis.

Pulmonary Dysplasia
What is the emergency?

(Congenital Diaphragmatic Hernia)

How to recognize Attempts to mask ventilatepatients worsens condition


Antenatal u/s mediastinal shift Hypoxia may become irreversible Difficulty in breathing Hypoxia < 8 hours Scaphoid abdomen Associated anomalies CXR

Newborn becomes increasingly dyspnoeic

Pulmonary Dysplasia
What is the pathology

(Congenital Diaphragmatic Hernia)

Hypoplastic, AbN lung(s) Hypoxia Referral to specialist hospital Fetal shunt reopens Antenatal Maternal Dexamethazone Fetal circulation bypassing lung Fetal surgery- Tracheal occlusion (Lig./Balloon/Clip) Post-delivery - N/g tube, CXR Low pressure Ventilation, Inability to ventilate adequately Management options

(JPS,1997;32(4):834-8)

Closure Open Sx / Thoracoscopically

Midgut Malrotation
What is the emergency?
Midgut loop ( from duodenum to middle of Colon) is volved

Howof to recognize patients Twisted portion gut may obstruct its own blood supply
Presentation due to vomiting or abdominal pain Vomitus is Bilious, may be intermittent, scanty Periods of well being, N feeding Contrast X-ray may show obstructed, volved gut.

Midgut Malrotation
What is the pathology
AbN fixation of bowel at beginning of 2nd trimester The above 2 allow for rotation Re-hydration IV fluids of midgut loop Urgent surgical total derotation of midgut.

are narrow they treated Results in How abnormally fixation of bowel mesentry

Oesophageal Atresia c. TacheoOesophageal Fistula Midgut Malrotation

Ano-Rectal malformations
What is the emergency?
These children are unable to pass meconium
Rectal distension leads to loss of function Males Colon perforates at either caecum or rectum

How to recognize patients

Females

This malformation has frequently assoc. congenital abN. LOW 40% 60%

HIGH

60%

40%

Ano-Rectal malformations
What is the pathology
This is a foetal developmental anomaly
The primitive Cloacal membrane has not divided into anal aims and urogenital channels Management to optimise sphincteric function Primary anoplasty / Defunctioning Colostomy The earlier the developmental process fails Posterior / continence Anterior / Laparoscopic. the AnoRectoplasty worse the childs potential

Management options

The emergencies discussed:


Intestinal obstructions
Gastroschisis Dysplastic lungs (CDH)

Midgut volvulus
Anorectal malformations
Thank you !