Paediatric Surgical Emergencies

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GASTROSCHISIS

  • This is a birth defect in the abdominal wall where the baby’s intestines are found outside the baby’s body exiting through a hole beside the umbilicus.
  • This differs from Omphalocele where the defect is paraumbilical and has associated intestinal abnormalities. They are more often noted in syndromic babies or noted to have other associated system abnormalities.

Treatment 

  • In the case of a gastroschisis, these babies have to be referred to a tertiary hospital at the earliest convenience. But before referral, the baby needs to be stabilized in the following way

NON-PHARMACOLOGICAL

  • Keep baby warm and check the random blood sugar
  • Cover bowels with a plastic. Do not cover with wet gauze as this makes the babies prone to hypothermia from the evaporation of the fluid
  • Insert an Orogastric Tube for decompression

PHARMACOLOGICAL

  • Establish IV access and give maintenance fluids (see paediatric section of fluid management).
  • Give Benzylpenicillin 50,000 iu/kg/dose STAT
  • Give Gentamycin 3.5mg/kg (preterm neonate) or 5mg/kg (term neonate) STAT
  • Give Vitamin K 0.5mg-1mg STAT

Referral with health personnel

HIRSCHSPRUNGS DISEASE

A congenital condition in which the rectum and part of the colon fail to develop a normal system of nerves, leading to an accumulation of faeces in the colon following birth.

Clinical FeaturesSIGNS AND SYMPTOMS

This may be suspected in

  • Delayed passage of stools/meconium in a neonate
  • Chronic constipation since birth
  • Some present later with signs of bowel obstruction (bilious vomiting, abdominal distension), poor feeding and failure to thrive

INVESTIGATIONS

  • FBC
  • AXR

Treatment 

NON-PHARMACOLOGICAL

  • This condition has a life-threatening complication of enterocolitis which may present with sepsis and shock from bacterial overgrowth
  • These patients need to be referred to a tertiary hospital.

PHARMACOLOGICAL

A rectal washout and antibiotics (Ceftriaxone 50mg/kg/dose and Metronidazole 7.5mg/kg/day) may be considered before referral in the event of:

  • Abdominal distension
  • Vomiting
  • Fever
  • Gush of stools on DRE.

*These are signs of an enterocolitis

INTUSSUSCEPTION

It is a process in which a segment of intestine invaginates into the adjoining intestinal lumen causing bowel obstruction.

Clinical Features

SIGNS AND SYMPTOMS

  • Vomiting (can be primarily non bilious and progress to bilious as the obstruction occurs)
  • Abdominal pain
  • Passage of blood and mucus PR (currant jelly stools)
  • Lethargy
  • Palpable abdominal mass

INVESTIGATIONS

  • FBC
  • AXR
  • Abdominal USS.

Refer to the nearest tertiary hospital after resuscitation.