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Duodenal atresiaDA Annular pancreasAP

JasminFlorian
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Duodenal atresiaDA Annular pancreasAP

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    1. Principles of neonatal Surgery Dr. Abdulrahman Albassam,FRCS (Edin) professor and Consultant , head section of Pediatric Surgery, Division of Pediatric Surgery, Department of Surgery, College of Medicine and King Khalid University Hospital, Riyadh

    2. Principles of 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

    3. Principles of Neonatal Surgery High intestinal obstruction in neonate Oesophageal atresia with/without Tracheo-esophageal Fistula (TOF) Infantile hypertrophy pyloric stenosis Duodenal obstruction: Duodenal atresia.(complete) web or stenosis Annular pancrease Ladd band (malrotation) Proximal jejunal obstruction: Atresia, web, stenosis.

    4. Oesophageal atresia & TOF Incidence: 1: 5000 live births, 50% associated with anomalies Types: Symptoms and Signs: Excessive salivation Respiratory Distress Inability to pass NG tube Choking and coughing on feeding

    5. Oesophageal atresia & TOF Diagnosis Clinical & CXR Management: Resuscitation Common type Right thoracotomy Division and repair of TOF Primary anastomosis Pure TOF Division and repair Isolated atresia >3 vertebra Staged surgery (gastrostomy and followed in 3-6 months by delayed repair. If fails then need esophageal replacement (stomach or colon)

    6. Infantile hypertrophy pyloric stenosis Incidence: 2-3 per 1000 live births, more in whites Age: peak 2-5 weeks Sex: 4:1 male predominance Symptoms and Signs: Projectile vomiting, non-bilious Failure to thrive Visible peristalsis Palpable mass

    7. Infantile hypertrophy pyloric stenosis Diagnosis Clinical and lab test Ultrasonography Contrast meal Management Correct dehydration and acid base with electrolytes pyloromyotomy either open or laparoscopic

    8. Duodenal obstruction Divided into: Complete (atresia) Partial (web, stenosis, ladd band,annular pancreas) Antenatal diagnosis: Polyhydramnios Dilated stomach and 1st part Duodenum Down syndrome 30% Symptoms and Signs: vomiting, bilious 80% High gastric aspiration: >30ml

    9. Duodenal obstruction X-rays: Double bobble shadow Management: Exclude the Volvulus NGT stabilized before surgery Duodeno-duodenostomy

    10. Proximal jejunal obstruction

    11. Case study A 3-day old baby boy who presented with H/O of vomiting which was formula milk and then green for last 12 hrs. He passed meconium last night. His mother told that his abdomen is full and feel firm. No perinatal problem O/E He is active and mildly dehydrated. Abdomen is distended and non tender with no mass. PR examination showed normal anus Plain X-rays was a lot of dilated loops with multiple fluid levels

    12. Clinical presentation

    13. Low intestinal obstruction in neonate- Differential Diagnosis Ileal/Colon atresia Meconium ileus Hirschsprung's Disease, Meconium plug syndrome, Left micro-colon syndrome ((Anorectal malformation)) Medical causes- sepsis, ileus, electrolytes imbalance

    14. Common presentations Bilious vomiting Failure or delayed to pass meconium Abdominal distension Multiple fluid levels in plain AXR

    15. Ileal /Colon atresia

    16. Meconium ileus

    17. Hirschsprung's Disease Due to congenital absence of ganglion cells in the distal bowel. Incidence: 1/4500-5000 live births Sex: 4:1 male predominance, Age: 96% Full term & 4% premature Site: Commonly: rectum/rectosigmoid Less commonly: total colonic with or without small intestine

    18. Hirschsprung's Disease Diagnosis Neonatal: * Delayed or failure to pass meconium with low intestinal obstruction. *late presentation: *Failure to thrive, *Poor feeding *Diarrhea with abdominal distension and occasionally with enterocolitis. Examination: Abdominal Distension PR: tight sphincter with gush of loose stool Malnutrited child, Enterocolitis

    19. Hirschsprung's Disease Diagnosis cont.. Radiographic studies: Plain AXR, unprepared barium enema Rectal biopsy Suction Full thickness

    20. Hirschsprung's Disease Management

    21. Anorectal Malformation (imperforate anus) Incidence 1:5000 live births Common in boys than girls(55%-65%) Low - below levator sling High - above levator slin Rectovestibular fistula - commonest in girls Rectourtheral fistula - commonest in boys

    22. Management at birth

    23. Posterior sagittal anorectoplasty (PSARP)

    24. ARM Closure of Colostomy

    25. Principles of Neonatal Surgery The newborn suspected of having intestinal obstruction should be studied in a logical step by step manner. It is important that it be definitely established that the infant has a surgical problem before surgery is performed. Resuscitation must be done before operation Every condition will be dealt according

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