Surgical Problems of the Neonate

Question 1

What is necrotizing enterocolitis?

Answer 1

It is damage to the intestinal tract which ranges from mucosal injury to full thickness necrosis and perforation

Question 2

At what age does NEC usually occur?

Answer 2

2-3 weeks of life. Higher risk if baby was born preterm and formula fed

Question 3

What are the signs & symptoms of NEC?

Answer 3

• diarrhea and vomiting (bile)
• abdominal distention/bloating
• delayed gastric emptying
• poor feeding

Question 4

Which part of the intestines does NEC usually affect?

Answer 4

• terminal ileum
• proximal ascending colon
• although other parts may be affected by varying degrees of NEC

Question 5

What is the diagnostic feature of NEC?

Answer 5

-pneumatosis intestinalis (intramural bowel gas)

Question 6

Where could obstruction of the bowels occur?

Answer 6

• intraluminal
• within the walls of the lumen
• compression of the intestines from the outside

Question 7

What is Hirschprung’s Disease?

Answer 7

-congenital defect in which some parts of the intestine lack innervation (aganglionic)

Question 8

How is Hirschprung’s diseases usually detected?

Answer 8

• a few days after birth due to failure to pass meconium within 24-48h
• in adulthood in the presence of megacolon

Question 9

What are the signs and symptoms of Hirschprung’s?

Answer 9

• green/brown vomit (bile)
• abdominal distention
• bloody diarrhea
• poor feeding

Question 10

How is hirschprung’s diagnosed?

Answer 10

• Dilated loops of bowel
• barium enema (transition zone between aganglionic and normal bowel. Proximal bowel is dilated in comparison with the constricted distal bowel
• Suction rectal biopsy

Question 11

What is meconium ileus?

Answer 11

• obstruction of terminal ileum by abnormally thickened meconium
• most often occurs in neonates with cystic fibrosis

Question 12

What are the features of meconium ileus?

Answer 12

• colon distal to the obstruction is narrow and is called a microcolon due to disuse.
• meconium pellets may be present distal to the obstruction

Question 13

What are the signs and symptoms of meconium ileus?

Answer 13

• failure to pass meconium within 12-24h
• abdominal distention
• loops of distended bowel may be palpated and is characteristically doughy

Question 14

What are the complications of meconium ileus?

Answer 14

• the bowels may form a volvulus
• loss of vascular supply will result in infarction of the bowel which can result in sterile meconium peritonitis
• infarcted bowel may be resorbed and cause intestinal atresia.

Question 15

How is meconium ileus detected?

Answer 15

• plain x-ray

- if positive, test for cystic fibrosis

Question 16

What is malrotation of the bowel?

Answer 16

• congenital anomaly of the small intestines
• during embryonic development, the bowels usually rotate counterclockwise so that caecum rests in the RLQ
• incomplete rotation causes the caecum to rest in the epigastric region/RUQ which may cause bowel obstruction

Question 17

How does bowel obstruction occur in malrotation?

Answer 17

• Ladd’s bands which usually attach the caecum to the peritoneum, stretches across the duodenum
• volvulus of the small intestine due to lack of normal peritoneal attachment. Twisting on the narrow stalk-like mesentery

Question 18

What is a stepladder sign?

Answer 18

-appearance of gas-fluid distended small bowel loops that appear to stack on top of one another

Question 19

How does a stepladder sign indicate at which level the obstruction has occured?

Answer 19

• higher number of steps-lower obstruction

- lower number of steps-higher obstruction