Surgical Surgical Emergencies In Emergencies In Neonatal Neonatal Dr.Mohammad Saquib Dr.Mohammad Saquib Mallick,FRCS Mallick,FRCS Associate Professor and Consultant , Associate Professor and Consultant , Division of Pediatric Surgery, Department Division of Pediatric Surgery, Department of Surgery, College of Medicine and King of Surgery, College of Medicine and King Khalid University Hospital, Riyadh Khalid University Hospital, Riyadh
Surgical Emergencies In Neonatal. Dr.Mohammad Saquib Mallick,FRCS Associate Professor and Consultant , Division of Pediatric Surgery, Department of Surgery, College of Medicine and King Khalid University Hospital, Riyadh. Principles of Neonatal Surgery. Types of Newborns: - PowerPoint PPT Presentation
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Mallick,FRCSMallick,FRCSAssociate Professor and Consultant , Associate Professor and Consultant ,
Division of Pediatric Surgery, Department of Division of Pediatric Surgery, Department of Surgery, College of Medicine and King Khalid Surgery, College of Medicine and King Khalid
University Hospital, RiyadhUniversity Hospital, Riyadh
Principles of Principles of Neonatal Surgery Neonatal Surgery
Types of Newborns:– Full-term: >38 weeks and weight >
2.5 kg – preterm infant: <38 weeks with
appropriate weight– SGA: >38 weeks and weight< 2.5 kg– VLBW: <32 weeks and <1.5 kg
There are physiologic differences between all these infants
Principles of Principles of Neonatal Surgery Neonatal Surgery
Metabolic considerations1: Thermoregulation2: Glucose homeostasis3: Calcium and Magnesium homeostasis4: Blood volume5: Jaundice6: Energy requirement
Fluid & Electrolytes Concepts1: water metabolism
Principles of Neonatal Principles of Neonatal Surgery Surgery
Duodenal obstruction:Duodenal obstruction:– Duodenal atresia or web or stenosisDuodenal atresia or web or stenosis
Annular pancreaseAnnular pancrease
– Ladd band (malrotation)Ladd band (malrotation) Proximal jejunal obstruction:Proximal jejunal obstruction:
– Atresia, web, stenosis.Atresia, web, stenosis.
Oesophageal atresia & TOFOesophageal atresia & TOF Incidence: 1: 5000 Incidence: 1: 5000 live births, 50% associated with live births, 50% associated with
anomaliesanomalies
Types: Types:
Symptoms and Signs:Symptoms and Signs:– Excessive salivation Excessive salivation – Respiratory DistressRespiratory Distress– Inability to pass NG tubeInability to pass NG tube– Choking and coughing on feedingChoking and coughing on feeding
Staged surgery (gastrostomy and Staged surgery (gastrostomy and followed in 3-6 months by delayed followed in 3-6 months by delayed repair. If fails then need esophageal repair. If fails then need esophageal replacement (stomach or colon)replacement (stomach or colon)
–Treatment: End to Treatment: End to end anastomosisend anastomosis
Case studyCase study A 3-day old baby boy who presented A 3-day old baby boy who presented
with H/O of vomiting which was with H/O of vomiting which was formula milk and then green for last 12 formula milk and then green for last 12 hrs. He passed meconium last night. hrs. He passed meconium last night. His mother told that his abdomen is His mother told that his abdomen is full and feel firm. No perinatal problemfull and feel firm. No perinatal problem
O/E He is active and mildly O/E He is active and mildly dehydrated. Abdomen is distended dehydrated. Abdomen is distended and non tender with no mass. PR and non tender with no mass. PR examination showed normal anusexamination showed normal anus
Plain X-rays was a lot of dilated loops Plain X-rays was a lot of dilated loops with multiple fluid levels with multiple fluid levels
Clinical presentationClinical presentationLow intestinal obstruction in neonate
Low intestinal obstruction in neonate-
Differential Diagnosis Ileal/Colon atresia Meconium ileus Hirschsprung's Disease, Meconium plug syndrome, Left micro-colon syndrome, Malrotation with volvulusMalrotation with volvulus ((Anorectal malformation))((Anorectal malformation)) Medical causes-Medical causes-
cont..cont.. Due to congenital absence of ganglion Due to congenital absence of ganglion
cells in the distal bowel.cells in the distal bowel. Incidence: Incidence: 1/4500-5000 live births 1/4500-5000 live births Sex:Sex: 4:1 male predominance,4:1 male predominance, Age: Age: 96% Full term & 4% premature96% Full term & 4% premature Site: Commonly: Site: Commonly: rectum/rectosigmoid Less commonly: total colonic with or Less commonly: total colonic with or
SymptomsNone to severePolyhydramniosPresents birth to after many days
SignsScaphoid abdomenAudible bowel sound in the chest
Diaphragmatic Diaphragmatic HerniaHernia
Diagnosis:– Prenatal <25wks, prognosis
bad– Clinical– CXR– 10% >after neonatal period
Diaphragmatic Diaphragmatic HerniaHernia
Diaphragmatic Diaphragmatic HerniaHernia
Management– Reussciataion and
stabilization– Laparotomy
Primary Patch by silo or
muscle– Laparoscopic repair
Eventration of Eventration of DiaphragmDiaphragm
Def: Abnormal elevation of diaphragm Def: Abnormal elevation of diaphragm that results in paradoxical motion of that results in paradoxical motion of affected hemidiaphragm during affected hemidiaphragm during inspiration and expirationinspiration and expiration