common surgical problems of the neonate

Question 1

Explain what the problem is here

Answer 1

Abdomen distended – with bowel loops

Liver is the space above the bowels – blackness around the liver ( air around the liver)

If you see air then there will be a leak – so there is a hole in the bowel (perforation) - air is in the wrong place

Loop of bowel – edge of bowel is sharp (air on the inside and the outside`0

Branching structure in liver – air in the portal system

All adding up to a picture in a baby born too soon and bowels are not ready so has developed a perforation (hole)

Loop of bowel sitting too low (hernia at the bottom)

Necrotizing enterocolitis – an umbrella term for disease

essentially a bowel perforation

Question 2

What are the three main problems in bowel obstruction

Answer 2

In the Lumen

in the wall

outside the wall

Question 3

Explain what is seen on this xray

Baby is born at term - doesnt pass any stool or the meconium (which is the first poo the baby does (black poo))

Signs of abdominal disention

Everything is quite sticky in the lumen

Answer 3

MECONIUM ILEUS

Left hand side looks a bit bubbly (material within the lumen)

Loops of black bowel (full on empty contrast)

• Start to the think there is something in the lumen and its stuck

Poo not coming through (other black circle)

Sticky poo – cystic fibrosis

(can present like this if they have a bowel problem) – intial poo wont move through

Question 4

Baby might feel floppy – signs on hands and feet

Not tolerating their feeds + abdominal film is not being taken

Not much gas going through – morphological features not quite right

Hold up of gas in bowel that is quite high

Answer 4

Down syndrome (duodenal atresia – problem with wall of bowel) - two conditions are usually seen together

Initial feeding milk cant go through

Question 5

What condition is this?

Vomit – green colouring, abdominal distention (further down)

Few loops and are distended

Answer 5

Jejunal atresia - the bowels come to a dead end (not connected)

Question 6

What condition is this and how can it be fixed

Answer 6

A hernia and can be fixed by reduction

Question 7

What is green bile?

If the child has green vomit what do they have until prven otherwise?

Answer 7

A RED FLAG SYMPTOM FOR BOWEL ISCHAEMIA

Malrotation and volvulus until proven they dont have it

contrast in the stomach moves through to the jejunum and then starts to spiral round when blocks off blood supply to the bowel.