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PEDIATRIC SURGICAL

EMERGENCY

Teuku Yusriadi, dr, Sp.BA


Introduction
 Pediatric surgical emergency diseases:
◦ Anatomical anomalies
◦ Physiological changes.
 Children are not little adults and the pediatric
physiology undergoes significant changes from
birth to adulthood.
 Pediatric surgical care requires a unique fund
of knowledge.
Introduction…
 Pediatric surgical emergency diseases
◦ Congenital
 Intestinal atresia, abdominal wall defect, Hirschsprung’s
disease, etc.
◦ Acquired
 Infection: NEC, appendicitis, intestinal perforation
 Trauma: Intra abdominal bleeding, peritonitis
 Tumor: Sacrococcygeal teratoma, bladder wall RMS
 Miscellaneous: Gastrointestinal bleeding, intraperitoneal
adhesion
Introduction…
 Pediatric surgical emergency diseases
◦ Neonatal & Pediatric
1. Neonatal:
 Esophageal atresia
 Congenital diaphagmatic hernia
 Intestinal atresia
 Abdominal wall defect
 Necrotizing enterocolitis
 Anorectal malformation
 Neonatal Hirschsprung’s disease
 Neonatal intestinal perforation
Introduction…

2. Pediatric:
 Hypertrophic Pyloric Stenosis
 Malrotation and midgut volvulus
 Incarcerated inguinal hernia
 Intussusception
 Appendicitis
 Intestinal perforation
 Gastrointestinal bleeding
 Testicular torsion
Clinical Manifestation
In general, pediatric surgical emergency cases is
manifest as follow :
1. Acute intestinal obstruction
2. Local or diffuse peritonitis
3. Abdominal wall defect
4. Respiratory distress syndrome
5. Gastrointestinal bleeding
6. Abdominal injuries
Clinical Presentation
 Hypersalivation
 Vomiting (bilious or non bilious)
 Abdominal pain (local or diffuse)
 Abdominal distention
 Obstipation
 Bloody stool
 Acute local pain
 Abdominal wall defect
 Respiratory distress
Clinical Presentation
Bilious Non Bilious Blood mix with
vomiting vomiting gastric juice
• Intestinal atresia • HPS • Midgut volvulus
• Anorectal • Duodenal • Gastric volvulus
malformation atresia pars I
• Hirschsprung’s • Gastric outlet
disease obstruction
• Necrotizing
enterocolitis
• Incarcerated
inguinal hernia
Clinical Presentation…

Abdominal Abdominal wall


Abdominal Pain
Distension defect
• Intestinal atresia • Intussusception • Omphalocele
• Necrotizing • Appendicitis • Gastroschisis
enterocolitis • Peritonitis • Incarcerated
• Anorectal • Midgut volvulus umbilical hernia
malformation • Incarcerated
• Neonatal inguinal hernia
Hirschsprung’s
disease
• Intestinal
perforation
Clinical Presentation…

Respiratory
Bloody Stool Acute Local Pain
Distress
• NEC • Incarcerated • Congenital
• Volvulus midgut inguinal hernia diaphagmatic
• Intussuception • Incarcerated hernia
• Gastrointestinal umbilical hernia • Esophageal
bleeding • Testicular atresia
torsion • Diaphagmatic
eventeration
Zona transisi pada HSCR

Abrupt cone funnel


Gastroschisis

Silastic Silo
Gastroschisis

Primary Closure Stage Closure


Necrotizing enterocolitis

NEC Grade III Penumatosis Intestinalis Peritoneal drainage


Intussuception
Sausage like mass Currant jelly stool Target’s sign

Meniscus sign

Intussusception
Property of Pediatric Surgery Division
Tuesday, May 15, 2018 Of Syiah Kuala Medical Faculty
By. Ny. Rina, L, 9 hari
Thank You