Surgical problems

Published on 03/06/2015 by admin

Filed under Neonatal - Perinatal Medicine

Last modified 03/06/2015

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CHAPTER 23 Surgical problems

Bile

Bile may appear in vomitus or in aspirates from gastric tubes. Bilious vomiting should always be considered as potentially serious, especially in a previously well baby when an acute volvulus should be suspected and ruled out.

Generally speaking, the presence of bile that has made its way into the stomach (and is seen in vomitus or gastric tube aspirates) indicates that the gut is obstructed. This obstruction may be complete or partial, and may be anatomical or functional (i.e. with a still patent lumen).

For anatomical causes of obstruction see pages 1313.

Functional gut obstruction can occur in babies in the following circumstances:

Sometimes bile is seen in aspirates when the feeding tube sits at or has passed through the pylorus — this can be confirmed on an abdominal X-ray. In an otherwise well baby, this can be fixed by pulling the tube back so that its tip lies in the body of the stomach.

Gastrointestinal perforation

Extremely preterm infants are prone to gastrointestinal perforation, which can occur in isolation or, more commonly, in association with necrotising enterocolitis (NEC; see below). If intestinal perforation is found, it does not automatically follow that NEC is present. It can be difficult to distinguish the two conditions pre-operatively, and risk factors are similar.

The management of infants with gastrointestinal perforation should include: