Neonatal Surgical Abdominal Distention Gaseous Fluid Ascitis Masses

Neonatal Surgical Abdominal Distention • Gaseous • Fluid ( Ascitis ) • Masses • Miscellaneous ( Pseudo obstruction )

Neonatal Surgical Abdominal Distention • Polyhydramnios • Family History • Antenatal Diagnosis

Neonatal Surgical Abdominal Distention Symptoms and Signs • Vomiting • Abdominal Distention • Passage of Meconium

Neonatal Surgical Abdominal Distention Gaseous Polyhydramnios , Antenatal Diagnosis , Family History Mild to moderate upper abdominal Moderate to severe, Uniform Positive meconium history Vomiting Non bilious Pyloric Atresia Supra ampullary D. A Early N E C Bilious Malrotation Infra ampullary D. A Proximal J. I Atresia Bilious Hirschprungs Disease Distal J. I Atresia Perinatal Perforation Meconium Plug syndrome Meconium Ileus NEC Bilious Absent Anus ARM.

Neonatal Surgical Abdominal Distention Pyloric atresia • Mild to Moderate Distention • Upper Abdominal • Non Bilious Vomiting

Neonatal Surgical Abdominal Distention CHPS • Non Bilious Vomiting • Visible Gastric Peristalisis • Pyloric Tumor

Neonatal Surgical Abdominal Distention Infra ampullary Duodenal Atresia Typical Double bubble appearance • Bilious Vomiting • Upper Abdominal Distention • High Incidence of Downs Syndrome

Neonatal Surgical Abdominal Distention Malrotation. Male Preponderance. Bilious Vomiting. Upper Abdominal Fullness. Bleeding P. R is the heralding sign of midgut Volvulus

Neonatal Surgical Abdominal Distention Proximal Jejuno-ileal atresia • Bilious Vomiting • Moderate Abdominal Distention • More than 2 air fluid levels

Neonatal Surgical Abdominal Distention Distal jejunoileal atresia . Bilious vomiting. Moderate to severe distention multiple air fluid levels

Neonatal Surgical Abdominal Distention Meconium ileus Rare in Asian community Recessive in inheritance Moderate to severe uniform distention Passage of scanty meconium

Neonatal Surgical Abdominal Distention Anorectal Malformations • Moderate to severe, uniform distention • Positive meconium history • Absent anus

Neonatal Surgical Abdominal Distention • • • Meconium passage Normal Within 24 to 48 hrs Spontaneous Copious Shiny Greenish

Neonatal Surgical Abdominal Distention Meconium passage Abnormal. Passage beyond 48 hrs. Passage after manipulation. Passed like a meconium plug

Neonatal Surgical Abdominal Distention Hirschprung’s Disease Moderate to severe uniform distention Positive meconium history (Delayed voiding of meconium beyond 48 hrs after birth)

Neonatal Surgical Abdominal Distention Congenital Megacolon-contrast study. No bowel preparation to be done. Post evacuation film may show classic zone of coning. Delay in evacuation beyond 48 hrs is in favor of congenital megacolon

Neonatal Surgical Abdominal Distention Pneumoperitonium- Perinatal GI Tract perforation. football sign Hollow viscus perforation. Gastric ( ? Idiopathic ). Caecum or appendix due to congenital megacolon

Neonatal Surgical Abdominal Distention NEC-Distended loops of bowel with pneumatosis intestinalis

Neonatal Surgical Abdominal Distention Fluid ( Ascitis ) • • • Urinary Ascitis Meconium Peritonitis Bacterial Peritonitis Biliary Ascitis Chylous Ascitis Hepatocellular

Neonatal Surgical Abdominal Distention Urinary ascitis ( P U V )

Neonatal Surgical Abdominal Distention Masses • • • PUJ Obstruction Duplication Cyst Multicystic Dysplastic Kidney Mesoblastic Nephroma Renal Hygroma Infantile Polycystic Kidney Mesentric Cyst Ovarian Cyst Neuroblastoma R. P Teratoma

Neonatal Surgical Abdominal Distention Miscellaneous ( Pseudo obstructions ) • • • Sepsis Hypothyroidism Extreme Prematurity Perinatal Hypoxia Narcotic Abuse

Neonatal Surgical Abdominal Distention NSAD-Team • • Pediatrician/Neonatologist Radiologist/Sonologist Pediatric surgeon/Neonatal surgeon Anesthesiologist/Pediatric anesthesiologist Pathologist/ Pediatric Pathologist. Conscientious Nurse Geneticist

Neonatal Surgical Abdominal Distention CONCLUSIONS. • Polyhydramnios is a marker of proximal G. I. Tract atresia • Previous sibling with G. I. Tract anomaly should alert the team and calls for prenatal scan. • A neonate with 10 ml of bilious gastric aspirate or bilious vomiting must me considered as a case of NIO unless proved otherwise.

Neonatal Surgical Abdominal Distention CONCLUSIONS • Any Neonate with delayed voiding of meconium beyond 48 hrs must be considered as a case of congenital megacolon • Passage of milk stools excludes atresia of G. I. Tract in a neonate • Bleeding per rectum in a suspected case of malrotation is a heralding sign of gangrene in a mid gut volvulus