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Surgical Emergencies
in the Newborn

Prof: Mohamed Khashaba

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 Learning Objectives
 Acquire knowledge about:
2. Fetal diagnosis.
3. Main congenital surgical emergencies.
4. General management prior to surgical
manipulation

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Fetal Manifestations
1. Polyhydramnios ( Volume >2 liters ).
2. Dystocia.
3. Meconium peritonitis.
4. Fetal ascites.
5. Oligohydramnios.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 1. Polyhydramnios
 In 1/1000 births.
 Gastrointestinal obstruction is the most
frequent surgical cause.
 Other causes include:
• Anencephaly
• Abdominal wall defect
• Diaphragmatic hernia

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Dystocia.2

 Resulting from fetal intestinal obstruction.

 Ascites.
 Abdominal wall defect

M.Khashaba,MD professor of Pediatrics,Mansoura

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 1. Meconium peritonitis

 Meconium Peritonitis due to perforation of

congenital intestinal obstruction.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 • Fetal Ascites
 Usually urinary tract anomalies.
 May be a component of generalized
edema.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 5.Oligohydraminos

 Renal hypoplasia ( Potter syndrome)

M.Khashaba,MD professor of Pediatrics,Mansoura

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Congenital Surgical emergencies
1. Lesions causing respiratory difficulty:
 Esophageal atresia
 Diaphragmatic hernia
4. Lesions causing intestinal obstruction:
 Duodenal atresia
 Imperforate anus
7. Intestinal perforation
8. Abdominal wall defect :
 Gastroschisis
 Omphalocele
M.Khashaba,MD professor of Pediatrics,Mansoura
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 II Postnatal manifestations
1. Respiratory Distress.
2. Scaphoid abdomen.
3. Excess mucus and salivation.
4. Gaseous distension.
5. Vomiting.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 1. Failure to pass meconium.
2. Hematemesis and bloody
stools.
3. Abdominal mass.
4. Birth trauma

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Lesions causing respiratory
difficulty
 Esophageal Artesia
 With tracheoesophageal fistula in 85%.
 Excessive salivation.
 Chocking with feeding.
 Pneumonia due to aspiration & reflux.
 Other anomalies may be associated
(VATER Syndrome)
M.Khashaba,MD professor of Pediatrics,Mansoura
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 Diagnosis

 X ray finding of the catheter coiled in the

upper pouch.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Diaphragmatic Hernia

 Commonest on the left side.

 Cyanosis & respiratory distress.
 Scaphoid abdomen.
 Heart displaced to the opposite side.
 Bag and mask ventilation is
contraindicated.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Diagnosis
 Prenatal polyhydramnios.
 Ultrasound
 Postnatal X ray

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Lesions causing intestinal
obstruction

Congenital Acquired eg

• Volvulus
Intrinsic : Extrinsic:
•-malrotation • NEC
• Artesia
•-Volvulus • Mesenteric
• Stenosis
thrombosis
M.Khashaba,MD professor of Pediatrics,Mansoura
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 Duodenal Artesia
 Associated with other malformation in 70 % of
cases , including Down syndrome.
 Prenatal diagnosis ( Ultrasound &
polyhydrmnios )

 Vomiting bile stained.

 Abdominal distension limited to upper
abdomen.
 Prolonged jaundice

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Diagnosis
 X ray : double bubble

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Imperforate anus

 After associated with other anomalies as

TEF , VATER syndrome.
 Two types high and low.
 May be associated with rectovaginal or
rectourinary fistula.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Intestinal perforation
 Commonest causes include
 Volvulus.
 Necrotizing enterocolitis.
 Meconium ileus.
 Mesenteric thrombosis.

M.Khashaba,MD professor of Pediatrics,Mansoura

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  Signs of intestinal obstruction.
 Signs of shock and sepsis.

M.Khashaba,MD professor of Pediatrics,Mansoura

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General Management of Surgical
Emergencies in the Newborn
1. Early diagnosis including prenatal use of
diagnostic tools.
2. Search for other associations.
3. Supportive measures.
 Respiratory support.
 Fluid &electrolytes replacement.
 Gastrointestinal decompression

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Adnominal wall defects
Gastroschisis.
 Full thickness abdominal wall defect.
 Extruded intestine, never has a sac.
 Umbilical Cord is an intact structure , to
the left of the defect.
 Other congenital anomalies are rare.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Management
1. Cesarean section is indicated.
2. Temperature regulation.
3. Protective covering.
4. Broad spectrum antibiotics.
5. Total parentral nutrition.
6. Surgical correction.

M.Khashaba,MD professor of Pediatrics,Mansoura

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 Omphalocele
1. Herniation of abdominal contents into
the base of umbilical cord.
2. Has a sac enclosing the abdominal
contents.
3. Umbilical cord lies cover the Sac.
4. Associated congenital anomalies in
25-40% of infants.
M.Khashaba,MD professor of Pediatrics,Mansoura
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 Management

 Manage as gastroschisis if the sac is

ruptured.
 Careful dressing of the sac is intact.

M.Khashaba,MD professor of Pediatrics,Mansoura

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