4. GASTROCHISIS
• Gastroschisis refers to an extra-abdominal
herniation (evisceration) of fetal or
neonatal bowel loops (and occasionally
portions of the stomach and or liver) into
the amniotic cavity through a para-
umbilical anterior abdominal wall defect.
6. OMPHALOCELE
Omphaloceles, also known as exomphalos
(rare plural: exomphali), are congenital
midline abdominal wall defects at the base
of the umbilical cord insertion, with
herniation of gut (or occasionally other
structures) out of the fetal abdomen.
7. OMPHALOCELE
• The risk of an associated
chromosomal anomaly is higher
when the omphalocele is
detected earlier in gestation
• Trisomy 18:
• Trisomy 13
• Trisomy 21
• Turner syndrome
• Klinefelter syndrome
Can be detected prenatally by maternal
raised serum alpha fetoprotein level.
8. DIFFERENCE BETWEEN GASTROSCHISIS AND
OMPHALOCELE
CHARACTERISTIC GASTROSCHISIS OMPHALOCELE
Defect size 2-3 cm 2-15 cm
Sac Never present Covered by peritoneal sac
Gestational age Prematuritity Term
Associated anamolies Uncommon Common ( 90 %)
Bowel character Inflammatory ,edematous Normal
Relation to umbilical cord Defect is right side of umbilical
cord
hernation of content through
umbilicus
9. Disorders of oesophagus
▶Oesophageal atresia +/- Tracheo-oesophageal fistula
▶Congenital oesophageal stenosis, webs and diverticula
▶Extrinsic compression –foregut duplication cyst
10. TRACHEO -OESOPHAGEAL FISTULA
• CLINICAL PRESENTATION :
- The presentation is usually in the first
few hours of life, with the newborn
having excessive oral secretions,
choking and
- Sometimes even cyanosis. Typically,
symptoms become
- More pronounced during the first feed
▶1 in 5000 births
▶M:F
▶ VACTERL anomalies
▶Down’s syndrome
11. Chest X-ray
Dilated proximal esophageal pouch with coiled
nasogastric tube within is diagnostic
Air in the stomach and the small bowel
15. CONTRAST STUDIES:
▶ Should be avoided, fear of aspiration
• Nonionic isoosmolar contrast medium
• H-type fistulas are mostly at the thoracic inlet,
between C7 and T2 vertebral bodies
24. • ‘STRING SIGN’ - hypertrophied
muscle mass causes elongation and
narrowing of pyloric canal
• “SHOULDER SIGN” -hypertrophy of the
pyloric muscle
25. Duodenal obstruction (Atresia ,Stenosis, Webs)
▶ Duodenal atresia (1 in 10000)
Most common of all intestinal
atresia
25% Downs syndrome
Clinical features:
- Bilious vomiting in the first few
hours of life is the cardinal symptom
31. Mid to distal bowel defects
▶ High bowel obstruction – Bilious vomiting
▶ Low bowel obstruction – Failure to pass meconium (< 48 hrs)
32. JEJUNAL AND ILEAL ATRESIA
JEJUNAL ATRESIA ILEAL ATRESIA
Caused by early vascular compromise of the
developing midgut.
Commonly associated with cystic fibrosis, thick
meconium can lead to ileal obstruction ( Meconium
ileus )
More likely to involve multiple sites Single site involvement
Associated with extra -GI anamolies and
chromosomal anamolies- 42 %
Less associated with extra -GI anamolies and
chromosomal anamolies- 2 %
33. JEJUNAL AND ILEAL ATRESIA ON ANC USG
The cutoff used to define dilated small bowel is greater than 7 mm for loop
diameter or greater than 13 mm for loop length.
34. Small Bowel Atresia /
High intestinal obstruction
Utero-vascular insults
Decreased intestinal perfusion
Ischaemia
37. Meconium ileus
Meconium consists of succus entericus
Cystic fibrosis > 80%
The lack of normal pancreatic enzymes leads to
thick, tenacious meconium that collects in the distal ileum
and cecum, occluding its lumen and resulting in high-grade distal small
bowel obstruction.
Meconium – viscid distal ileum and colon
39. Meconium peritonitis
▶ Bowel perforates as a result of bowel
obstruction, such as atresias or meconium ileus
▶ Meconium peritonitis and small bowel
obstruction is highly suggestive of atresia.
40. Low bowel obstruction
▶ Difficult to differentiate on X-ray
▶Contrast enema is usually required
▶Water soluble contrast is preferred
41. Anorectal Anomalies
▶ Anal atresia: VACTERL association
Range from a membranous separation to complete absence of
the anus.
▶RADIOGRAPH:
- Invertogram
42. INVERTOGRAM
A coin/metal piece is placed over the
expected anus and the baby is turned upside
down (for a minimum of 3 minutes).
The distance of the gas bubble in the rectum
from the metal piece is noted:
>2 cm denotes high type
<2 cm denotes low type
False-positives may occur if the image is
taken in the first 24 hours of life or if there is
impacted meconium within the distal rectum.
43. ▶ ULTRASOUND:
▶ Delineating distance from the distal pouch to perineum
▶ CYSTOGRAPHY:
▶Delineates associated fistulas between terminal bowel and urinary tract.
▶MRI
▶Modalities of choice
▶Help determine presence of puborectalis muscle, external sphincter and
rectal pouch.
44. Hirschsprung’s Disease
▶ Absence of ganglion cells in bowel wall
▶ Transition point found in the rectosigmoid (73%) >
descending colon (14%) > more proximal colon
(10%).
47. Enteric Duplication Cyst
▶ Embryological abnormalities that are lined by
intestinal mucosa- Typically have double
layer called GUT SIGNATURE
▶Distal ileum (35%) > distal esophagus (20%) >
stomach (9%) > duodenum > jejunum.
54. INCOMPLETE ROTATION AND
MALFIXATION
▶ Failure to complete the final 180-degree rotation.
▶ Shortened mesenteric root -allows formation of elongated and mobile
segments of colon.
▶ Midgut volvulus.
56. ▶ REVERSED INTESTINAL ROT
ATION –
▶ Transverse colon lie behind the descending
duodenum and the superior mesenteric artery
▶ cecum is can be medially placed
57. Midgut volvulus
▶ Narrow mesentery
▶ Suddenly presents with bilious vomiting
▶ Ischemia and necrosis
▶ Plain radiograph
58. Ultrasound
▶ Clockwise whirlpool sign
▶ Abnormal bowel
▶ D ilated duodenum proximal to obstruction
▶ D ilated fluid-filled loops of small bowel
▶ free intra-abdominal fluid
Whirlpool sign on USG
59. Corkscrew sign
Tapering or beaking of the bowel in
complete obstruction
Malrotated bowel configuration
Fluoroscopy: contrast study
60. Meckel’s Diverticulum
▶ Congenital intestinal diverticulum
▶ Omphalomesenteric duct fails to
be completely obliterated
▶ Present with obstruction or
ulceration
▶ Antimesenteric border
▶ Litters hernia
Rule of twos”, i.e. it is found in
1)2% of the population,
2)Twice as common in males,
3)Most frequently found in
those less than 2 years of age
4)2 feet from the ileocecal
valve.
5) 2 inches in length.
6) Contain 2 mucosa - gastric
and intestinal.
61. ▶ Xray – Non specific
▶ SBFT with a large Meckel
diverticulum
63. Megacystis-microcolon-intestinal
Hypoperistalsis Syndrome (Berdon’s Syndrome)
• Megacystis-microcolon-
intestinal hypoperistalsis
syndrome
is a pseudoatresia. There is a
functional small bowel
obstruction with a microcolon,
malrotation and a large
unobstructed
bladder. There is four-to-one
female predominance with
