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LIFE THREATENING IN

NEONATUS CASES

CATUR SUZANTRA SUTISNA

RUMAH SAKIT MITRA KELUARGA


KELAPA GADING
Jakarta, 09 September 2004
NEONATAL SURGICAL TEAM

 NEONATOLOGIST

 PAEDIATRIC ANAESTHETIST

 NICU

 PAEDIATRIC SURGEON
CONGENITAL ABNORMALITIES

 ESOPHAGEAL ATRESIA (+ TRACHEO


ESOPHAGEAL MALFORMATIONS)

 INTESTINAL ATRESIA (DUODENUM,


JEJUNAL, ILEAL & COLONIC
ATRESIAS)
CONGENITAL ABNORMALITIES

 ANORECTAL MALFORMATION

 MEGACOLON CONGENITAL
(M. HIRSCHSPRUNG)

 GASTROSCHIZIS & OMPHALOCELE

 NEC, PEROTINITIS
ESOPHAGEAL ATRESIA
 EVERY : 3.000 LIVE BIRTHS

 86% WITH A DISTAL TRACHEO ESOPHAGEAL


FISTULA

 DIAGNOSIS : HYDRAMNION, HYPERSALIVATION


CHOKING, PNEUMONIA, VACTERL

 MANAGEMENT :
– CONSTANT SUCTION, UPRIGHT POSITION, GASTROSTOM
– PRIMARY REPAIR
Esophageal Atresia
Esophageal Atresia
Esophageal Atresia
Esophageal Atresia
Esophageal Atresia
INTESTINAL ATRESIA
 CLINICAL PRESENTATION : HYDRAMNION,
BILE VOMITING, MECONIUM (+),
ABDOMINAL DISTENTION.

 DIAGNOSIS : X-RAY
– DOUBLE BUBLE  DUODENAL ATRESA
– 3-6 BUBLE  JEJUNAL ATRESIA
– > 6 BUBLE  ILEUM ATRESIA

 END TO END INTESTINAL ANASTOMOSIS


Duodenal Atresia
 Fails to recanalize in the early embryonic
stages
 Complex, partial, web
 Diagnosis : Bilious vomiting, nondistended
infant
 X-ray : double-bubble sign
 Management : NGT, fluid resuscitation, AB
 Duodenoduodenostomy
Duodenal Atresia
Jejunal, Ileal, and Colonic
Atresias
 Bilious vomiting after 24 hours life
 Abdominal distention
 Diagnosis :
 X-ray : Bubble > 3, air fluid level
 Management end to end : intestinal
anastomosis
Ileal Atresia
MANAGEMENT
 DUODENAL ATRESIA  NOT TRUE
EMG

 JEJUNAL, ILEAL, COLONIC ATRESIA


 TRUE EMG
Diaphragmatic
Hernias/Eventerasio
 Foramen of Bochdalec (most)
 Foramen of Morgagni

Diagnosis
 Tachypnea, dyspnea, cyanosis/scaphoid, bowel
sound in hemithorax
 Ches X-Ray : mediastinal shift away
atelectasis, intestin
Management : repair defect
Diaphragmatic Hernia
Megacolon Kongenital
(M. Hirschsprung Disease)

 Clinical Presentation :
– Non passage of meconium (> 24 hours)
distention, bilous vomiting/enterocolitis
 Diagnosis :
– X-Ray : air fluid level & distended
– Ba enema : transition zone
– Biopsy : seromusculer, full thicknes, suction
Megacolon Kongenital
(M. Hirschsprung Disease)

 Management :
– Prepared for surgery
– Decompression, irrigation with saline-AB
– Colostomy
– Swenson, Duhamel, Soave
Gastroschisis

 Opening in abdominal wall/ site umbilicus


 Protruding viscera, mid portion of small intestine,
spleen, stomach, colon, occasionally the liver
 Associated : intestinal atresia
 Management :
– Decompression, i.v. fluids, AB, plastic covering
– Primary closure, silastic sheeting, stage repair
GASTROSCHISIS
GASTROSCHISIS
Omphalocele
 At the umbilicus
 A sac covers the extruded visceral contents,
no signs of peritonitis
 Primary closure, stage repair
 Important : size of the defect
 Skin flap  ventral hernia
 Silastic sheeting
OMPHALOCELE
Necrotizing Enterocolitis
 Etiologi & underlying mechanism :
unknown, bacterial infection, hypoxia,
umbilical artery catheterization, aortic
thrombosis
 Diagnosis :
– Lab : leucopenia, thrombocytopenia, low
hematocrit, metabolik acidosis & coagulation
defect
Necrotizing Enterocolitis
 Diagnosis :
– Abdominal X-Rays : distended, edematous
intestine pneumatosis (intramural air) portal
vein gas, persisten, loop bowel, free air.
 Medical management : AB, NGT
 Operative management : perforation
 Mortality rate : 20%
Anorectal Malformation
2 type : - Infralevator (low) type
- Supralevator (high) type

 Incidence = 1: 1.500 – 1:5.000 births


Male – female = 2:1
 No fistel = EMG
 Fistel : efective (+) : delayed
(-) : cito
 VACTERL
 Prognosis :
– In appropriate management
– Associated neurologic dysfunction