الفهرس 
Anatomy and EmbryologyOnly 14 pages are availabe for public view
 |  | from | 104 |  |  |
| | | from | 104 | | |
Abstract
Neonatal intestinal obstruction is the most common surgical emergency in the neonatal period. Bowel obstruction incidence is 1 in 2000 live births. The 4 cardinal signs of intestinal obstruction in newborns are (1) maternal polyhydramnios, (2) bilious emesis, (3) failure to pass meconium in the first day of life, and (4) abdominal distention. Any infant with bilious vomiting should be considered to have malrotation and midgut volvulus until proven otherwise.
Pyloric stenosis:
Is the commonest cause of gastric outlet obstruction. The repeated vomiting leads to dehydration and classical Ramstedt’s pyloromyotomy Other rarer causes include pyloric web or atresia.
Duodenal atresia
Vomiting and upper abdominal fullness are consistent findings with duodenal atresia. An infant with duodenal atresia may present with bilious or nonbilious vomiting, depending on the location of the obstruction with respect to the ampulla of Vater. In 85% of patients with duodenal atresia, the obstruction lies distal to the ampulla, and these patients have bilious vomiting.
Jejunoileal atresia
Infants with jejunoileal atresia may present with abdominal distention, vomiting, and obstipation. A hugely dilated (thumb-sized) loop of intestine denotes intestinal obstruction (the so-called rule of thumb).
Malrotation with volvulus
The initial presentation of a newborn with volvulus of the midgut is often bilious vomiting.. As blood flow in the superior mesenteric pedicle is compromised, the bowel becomes ischemic and dilates, and the baby’s abdomen becomes increasingly distended and firm Passage of frank blood per rectum may also occur. Prompt surgical intervention is required.
Meconium ileus and plug syndrome
Meconium ileus usually presents with abdominal distention and constipation. Patients who present with meconium ileus should be evaluated for cystic fibrosis. Meconium plug syndrome is a relatively benign condition, usually occurring in healthy-appearing term infants. Abdominal distention and failure to pass meconium within the first 24 hours of life are the presenting signs.
Hirschsprung’s disease
The most common history associated with Hirschsprung disease of a term newborn is either failure to pass meconium in the first 24 hours of life or chronic constipation after discharge from the nursery.. Failure to recognize Hirschsprung disease early may eventuate in toxic megacolon and death.
Imperforate anus
Routine inspection of a newborn perineum should include notation of the position and patency of the anus. Anorectal malformations range from anterior displacement of the anal opening to a completely imperforate anus. Many infants with imperforate anus have an abnormal sacral progression, as well as a fistula between the rectum and the genitourinary tract, demonstrated by finding meconium in the urine.
Neonatal Necrotizing Enterocolitis
is one of the most common gastrointestinal emergencies observed in neonatal intensive care units. Intestinal stenosis or stricture occurs in approximately one third of medically treated infants surviving the acute phase of NNEC The mainstay of surgical treatment is resection with enterostomy, although resection and primary anastomosis is useful in selected cases. In addition, some neonates may benefit from peritoneal drainage, second-look procedures, or proximal diversion