Bowel Obstruction: Infants and Children Age specific: Adhesions, Malrotation, intusception, meckel’s, appendicitis (“febrile obstruction”) Hx + Physical much closer to adults

Presentation Four cardinal signs of intestinal obstruction in neonate Antenatal polyhydramnios Bilious vomiting Delayed passage of meconium (> 24 hrs) Gastric residual > 30 cc Cardinal sing in adult Vomiting Abdominal pain Abdominal distension Obstipation/ constipation

Perioperative Management Fundamental rule: previous losses /maintenance/ongoing needs Urine output best measure of adequate resuscitation ?Need for central monitoring if problematic Recall distribution of various IV solution Bolus: as per PALS (20 cc/kg) Titrate to heart rate, urine output BP ↑ Maintained 25% for each quadrant of abdomen involved Antibiotics if any viscus opened, cardiac issues, immunosuppresed (newborn) Steroids: if on previously/deficiency (stress dose physiology) Nasogastric tube (Decompression) Keep patient warm

Be Aware of Child with Bilious (Green) Vomiting

Malrotation 10th Week of Development rapid growth of intestine which returns to abdominal cavity with rotation Problems can occur at any of the 3 stages Duodenal rotation Elongation and fixation of the mesentery Rotation of the colon

Tracheo-esophageal fistula Presentation Maternal polyhydramnios on U/S Drooling, choking, coughing, cyanosis with feeding  tracheomalacia No passage of NG tube VACTERL (Vertebral, anal, cardiac, tracheal, esophageal, renal, limb) Work-up Complete physical exam CXR, AXR – vertebral / rib anomalies Echocardiogram – aortic arch L vs. R to plan incision Renal U/S CT head in selected patients Pneumonitis prevention and treatment Parenteral antibiotics – gentamicin, ampicillin Sump suction catheter (Replogle) Treatment  surgical repair

Meckel’s Diverticulum's True diverticulum's Result from persistence vitelline duct and the omphalomesenteric duct. Incidence 2%, Most of these people remain asymptomatic throughout life. Role of 2. Complication: hemorrhage, acute diverticulitis, perforation, and small bowel obstruction or intussusception

Intussusception

Duodenal Atresia/ Annular Pancreas Primary problem is one of recanalization of solid duodenum. Obstruction typically at level of common bile duct and pancreas Associated anomalies common: almost 50% Down syndrome 29% malrotation 19% congenital heart disease 17% TEF 7% Others (renal, respiratory, imperforate anus - roughly 10%)

Jejunal & Ileal Atresia Pathology related to late second trimester vascular accident (Barnard) Associated anomalies rare Classification system

Imperforated Anus

Hirschsprung’s

Meconium Ileus

NEC

Abdominal Wall Defect Omphalocele Gastroschisis

Wilms tumor asymptomatic abdominal mass Well baby rapid abdominal enlargement ( pain, fever, and gross hematuria). 2 to hemorrhage Treatment is surgical resection

Neuroblastoma Neuroblastoma cells are derived from the primitive neural crest It was found that patients with an increased number of copies of the N-myc gene had a much worse prognosis Site: adrenal, retroperitoneum, mediastinum & neck. Treatment: surgery +/-chemotherapy

Duplication Cyst

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