3. TEF
• Most Common, Type C – 85%
• Dx – Inability to pass NGT/KUB/CXR
• Tx – R. Extrapleural thoracotomy at 4th intercostal
– TEF ligation/transection, restoration of esophageal continuity
– POD 5-7 esophagram, no leak begin oral feeds
• CX – GERD, leak, empyema, stricture, fistula
4.
5. Malrotation
• Sx: Bilious emesis , <2yo
• Dx: upper GI-
– Birds beak 3rd part of duo, Ligament of Treitz is right of midline
• Tx – surgical emergency, resuscitate, immediate surgical
exploration
• Path: failure of CCW 270 rotation, Ladd’s bands
6. Malrotation
• Ladd’s Procedure
– Resuscitation
– Resect bands
– CCW rotation of
bowel
– Cecum in LLQ
– Duodenum in RUQ
– Appendectomy
8. Duodenal Atresia
• Dx – Double bubble
– NO distal air – if distal air
present concern for
midgut volvulus
• Tx – Duodeno-
duodenostomy
– Duodenal webs
9. Hirschsprung’s Disease
• Failure of neural crest cells
to migrate in caudal
direction–
– Absent ganglia in
myenteric/submucosal
plexus
• Sx – Failure to pass
meconium in first 24 hours;
distension, constipation,
emesis
• Dx – Barium enema; biopsy
confirm absence of
ganglion cells
10. Hirschsprung Disease
• Tx – Resect colon
proximal to where
ganglion cells appear
• Pull through procedure
(Soave, Duhamel)
• Hirschsprung colitis- abd
distension, foul smelling
diarrhea, sepsis
• Resuscitate, antibiotics, rectal
irrigation and washout
• Colectomy with temporary
colostomy
11. Necrotizing Enercolitis (NEC)
• Sx- bloody stools after
first feeding in
premature infant
• Dx- KUB
– pneumatosis, portal V
gas
• Tx – NPO, NGT, Abx,
serial Abd X-rays
12. NEC
• Indications for OR –
– Free air, peritonitis
– Abd wall
erythema/cellulitis
– Electrolytes
– Worsening distention
• Resect affected
intestine, end
ileostomy, mucous
fistula
• Reanastamose 4-6
weeks
13. Hypertrophic Pyloric Stenosis
• Thickening of pylorus,
Gastric outlet
obstruction
• Presents 3-6 weeks old
• Projectile, non bilious
emesis
• 4:1 M:F, palpate
“olive” in 50%
15. Intussusception
• Invagination of intestines –lead points
– Lymphoid hyperplasia
– Meckel’s
– Lymphoma
• 3 months to 3 years old
• Sx- RUQ pain, Currant Jelly Stool, sausage mass
• Tx- reduce with air-contrast enema
• OR – Unsuccessful reduction, 3rd episode,
Peritonitis, free air
– Pressure to distal and squeeze out proximal.
26. Pulmonary Sequestration
• Does NOT communicate with
tracheobronchial tree
• Aberrant blood supply
• MC at LLL
• Intralobar – Drains through pulm V, no other
anomalies, resect due to bleeding risk
• Extralobar – drains through systemic V,
Associated with other anomalies, Observe and
delay resection until 6-9mo
27. Congenital Lobar Overinflation
• Air trapping “emphysema” hyperexpansion of
involved portion
• LUL most common
• Commonly found incidentally in asymptomatic
patients
• May mimic signs of Tension PNX with
mediastinal shift on CXR – do NOT place chest
tube as can be lethal
29. Kasai
• Resect fibrotic gallbladder/extrahepatic biliary tree
• RNY, Roux limb sutured to transected porta hepatis –
re-establish bile flow from minute bile ducts
• Transplant – Failed Kasai, decompensated liver disease,
late diagnosis
30. Hemangioma
• MC tumor of childhood and infancy
• Appears at birth and grows rapidly in first
12 months but then involutes
• TX:
– Most resolve by 5-6yo
– If uncontrolled growth, impairs function,
persists after 8yo, then
• Oral steroids
• Laser or Resection
