Pediatric surgery is a sub speciality of surgery pertaining to patients ranging from new-borns to 18 years of age. It comes with its own challenges that differentiate it from other surgeries. Whether it is the small size of babies and children to be operated or dealing with their responses to illness or surgery, every aspect of Pediatric Surgery needs special attention. Hence, there is a rationale for a dedicated division for Paediatric Surgery.

1. Neonatal surgical
Emergencies
Dr Prashant Jain
Sr Consultant
Ped. Surgery & Ped Urology
Dr BLKSS Hospital

2.  Gastro-Intestinal
 Abdominal wall defects
 Respiratory distress

3. Intestinal Obstruction
 Bilious Vomiting
 Abdominal distension
 Failure to pass meconium

4. Neonatal Intestinal Obstruction
Bilious Vomiting
+/- fail to pass meconium
Abdominal Distension
+/- Bilious vomiting
+/- fail to pass meconium
Upper GI Obstruction
 Duodenal Atresia
 Malrotation
 Jejunal/ileal/colonic atresia
 Meconium ileus
 Anorectal malformation
 Hirschsprung’s Disease
Small or large bowel

5. PASSAGE OF MECONIUM
• CANNOT RULE OUT OBSTRUCTION
• CAN PASS EVEN IN CASES OF ATRESIA

6. Causes
 Intestinal atresia
 Malrotation with or without Midgut volvulus
 Meconium ileus
 Meconium Peritonitis
 Ano-Rectal Malformation
 Hirschsprung’s Disease

7. CASE
 Term male child 2.7 Kg
discharged after delivery
 Passed meconium
 Antenatal history normal
 Presented at day 5 with
yellowish vomiting
 Admitted and managed
conservatively

8.  Again presented after 8 days with bilious vomiting

9. MALROTATION WITH MID GUT VOLVULUS
Exploratory Laparotomy

10. Malrotation is a TRUE SURGICAL EMERGENCY
• X-Ray
• Upper GI study
• USG

11. Normal
 Acute Intestinal Obstruction
 Recurrent abdominal pain and vomiting
Malrotation Volvulus

12. CASE
 Bilious vomiting
 Antenatal scan:
Polyhydramnios
 Down’s Syndrome

13. Duodenal Atresia
Double Bubble

14.  Bilious vomiting/aspirates
 Mild upper abdominal
distension
 Antenatal H/O of
Polyhydramnios
 D/D: Jejunal Atresia
Triple Bubble
CASE

15. • Bilious vomiting/aspirates
• Progressive abdominal
distension
Multiple air fluid level
Ileal Atresia
• Ileal atresia
• NEC
• Total colonic
aganglionosis
• Meconium Ileus
D/D
CASE

16. Colonic Atresia
CASE

17. Intestinal Atresia

18. CASE
• Abdominal distension
from birth
• Antenatal scan: Echogenic
and dilated bowel
• X-ray

19. Abdominal distension since birth
 Meconium ileus
 Meconium peritonitis/ascites
 Abdominal lump
 Ascites

20. Meconium Ileus
• Gastrograffin enema

21. Exploration

22. CASE
 Term male Newborn
 Antenatal scan s/o
echogenic bowel
 Bilious aspirates &
not passed meconium
 Abdominal distension
since birth

23. Meconium Peritonitis

25. Ano-Rectal Malformation
Vestibular Fistula
Anteriorly placed anus
Bucket Handle deformity
Anocutaneous Fistula

26. Ano-Rectal Malformation
Perineal Examination
Fistula
Anoplasty or
Pull through after
3mths
No Fistula
24 hrs
Cross table Xray
Colostomy
Pull through after 3 months

27. Aganglionosis can extend to variable distance
• Short segment – Classical
Rectosigmoid (60-70%)
• Long Segment (15-20%)
• Total colonic
aganglionosis (5-10%)
• Ultrashort segment
Hirschsprung’s Disease

28. Presentation
• Characteristically disease of full term newborn
• History of constipation dating back to newborn
period
• 95% of newborns defecate in first 24 hrs
of life
• Abdominal distension
• Poor feeding
• Failure to thrive

29. Investigations
• Barium Enema
• Rectal Biopsy

30. Definitive Pull through
for Hirschsprung’s Disease
• Single stage at age 3-6 months
• Two stage at 6-12 months after
colostomy

32. Primary Laparoscopic Assisted
Pull through

33. Respiratory Distress

34. • Day 1, Term 39 wks,
delivered in Sonepat
• Antenatal scan:
Polyhydramnios
• Respiratory distress
• Intubated and transferred
in BLK
A new born with
respiratory distress
CONGENITAL DIAPHRAGMATIC HERNIA

35. Congenital Diaphragmatic Hernia
Minimal Barotrauma
• Conventional Ventilation
• High frequency ventilation
• ECMO
Cardio-Pulmonary Stabilisation
(Pulmonary Hypoplasia + Hypertension)
Invasive & Noninvasive
monitoring

36. Day 1
• Respiraory acidosis
(Ph 7.26/PO2 118/Pco2 47/Hco3 20.1)
• Assisted control ventilation
– Fio2 100%
– PIP/PEEP: 15/5
• Dopamine and Adrenaline (Mean 50mm Hg)
• Cardiac Echo: Mild Pulmonary Hypertension

37. Day 2
• One episode of desaturation
• Respiratory acidosis
• Shifted on HFO
MAP 14
Fio2 100%
Delta P 30
• Stable

38. Day 3
• Desaturated
• Rt Pneumothorax- Drained
• Stable

39. Day 4(CDH Repair)

40. Post Operative Course
• Stable on ventilator (PSV)
• Had collpase/ consolidation of Rt
Lung….managed conservatively
• Extubated on POD 9
• Discharged on POD 13
• Asymptomatic now at 3 months

41. A new born with
respiratory distress
Cystic adenomatoid malformation

42. Air filled cystic spaces:
Congenital Cystic Adenomatoid Malformation

43. Respiratory distress
CONGENITAL LOBAR EMPHYSEMA

44. CDH CCAM Pneumatocoel

47. pneumothorax
CLE CLE