Acute abdomen in_pediatric

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  • 1. Acute abdomen inAcute abdomen in pediatricpediatric DR.MEDHAT M, IBRAHIMDR.MEDHAT M, IBRAHIM CONSULTANTCONSULTANT PEDIA,SURGERYPEDIA,SURGERY
  • 2. Definition of the acuteDefinition of the acute abdomenabdomen This is an abdominal condition whichThis is an abdominal condition which interfere with the normal live and makeinterfere with the normal live and make patient ask the medical advice with in fewpatient ask the medical advice with in few hours.hours. Emergent abdominal condition is theEmergent abdominal condition is the abdominal condition need for immediateabdominal condition need for immediate interference with out any delay.interference with out any delay.
  • 3. EtiologyEtiology InflammatoryInflammatory Traumatic ?Traumatic ? ObstructiveObstructive VascularVascular
  • 4. Age related causeAge related cause Neonatal causesNeonatal causes :: Necrotizing enter colitisNecrotizing enter colitis Obstructive causesObstructive causes Mega colonMega colon Meconieum plugsMeconieum plugs Atresia and its typesAtresia and its types malrotatinmalrotatin Birth injuriesBirth injuries Infant causesInfant causes:: GastroenteritisGastroenteritis NonspecificNonspecific abdominal painabdominal pain Complicated herniaComplicated hernia IntussusceptionsIntussusceptions malrotationmalrotation Volvulus and vascularVolvulus and vascular insufficienciesinsufficiencies
  • 5. Age related causesAge related causes Child age acute abdomen:Child age acute abdomen:
  • 6. Presentation of acute abdomenPresentation of acute abdomen Abdominal painAbdominal pain Abdominal massAbdominal mass Organ dysfunctionOrgan dysfunction BleedingBleeding
  • 7. Upper G I T bleedingUpper G I T bleeding Endoscopic images from children with (a) a normal esophagus, (b) an esophagus with erosive reflux esophagitis, and (c) an esophagus affected by eosinophilic esophagitis. Eosinophilic esophagitis, distinct from GERD, often appears as in this image, with furrowing of the esophageal mucosa, and white
  • 8. Abdominal tumors Neuroblastoma lymphoma Willms tumors Rabdomyosarcoma
  • 9. Abdominal tumors (renalAbdominal tumors (renal((
  • 10. Intestinal lymphomaIntestinal lymphoma Tumor induce abdominal pain ,mass,andTumor induce abdominal pain ,mass,and intestinal obstractionintestinal obstraction Obstractin is the indecation of surgeryObstractin is the indecation of surgery
  • 11. Inflammatory causesInflammatory causes Primary bacterial peritonitisPrimary bacterial peritonitis spontaneous bacterial peritonitisspontaneous bacterial peritonitis spontaneous bacterial peritonitis in healthy patientsspontaneous bacterial peritonitis in healthy patients Secondary bacterial peritonitisSecondary bacterial peritonitis visceral perforation, inflammation, tumorvisceral perforation, inflammation, tumor (pathology)(pathology) Tertiary bacterial peritonitisTertiary bacterial peritonitis most bad prognosis it is usually occur in ICUmost bad prognosis it is usually occur in ICU patientspatients
  • 12. Gut perforation secondaryGut perforation secondary peritonitisperitonitis
  • 13. Plain X-Ray in perforated gutPlain X-Ray in perforated gut
  • 14. TraumaticTraumatic That abdominal condition is not includingThat abdominal condition is not including the abdominal trauma which was need forthe abdominal trauma which was need for specific different management.specific different management. Bleeding and Gut contents causedBleeding and Gut contents caused peritonitis.peritonitis.
  • 15. ObstructiveObstructive Hollow organ obstructive disordersHollow organ obstructive disorders Most common colon (spastic colon andMost common colon (spastic colon and irritable bowel syndrome)irritable bowel syndrome) Obstructive type of acute appendicitisObstructive type of acute appendicitis Intestinal obstructionIntestinal obstruction Obstructive uropathyObstructive uropathy Bilary colicBilary colic
  • 16. VascularVascular Acute ischemiaAcute ischemia Necrotizing enter colitis is the mostNecrotizing enter colitis is the most common cause in neonatecommon cause in neonate The entropic drugs become the mostThe entropic drugs become the most common cause in the childrencommon cause in the children Intussusceptions and VolvulusIntussusceptions and Volvulus Strangulated herniaStrangulated hernia
  • 17. MalrotationMalrotation The commonest features of malrotation are:The commonest features of malrotation are: (1)the D-J flexure lies right of midline,(1)the D-J flexure lies right of midline, (2) the dorsal mesenteric attachment is narrow(2) the dorsal mesenteric attachment is narrow (3) peritoneal folds cross from colon and Caecum to(3) peritoneal folds cross from colon and Caecum to duodenum, liver and gallbladder (Laddduodenum, liver and gallbladder (Ladds bands), thuss bands), thus possibly obstructing the duodenum. Whether Laddpossibly obstructing the duodenum. Whether Laddss bands are substantial enough to cause mechanicalbands are substantial enough to cause mechanical obstruction is debatable. The narrowed mesentericobstruction is debatable. The narrowed mesenteric base can lead to midgut volvulus, bowel obstructionbase can lead to midgut volvulus, bowel obstruction and mesenteric vessel occlusion.and mesenteric vessel occlusion.
  • 18. Congenital band of Ladd'sCongenital band of Ladd's
  • 19. MalrotationMalrotationMalrotationMalrotation
  • 20. MalrotationMalrotation Cork screw upperCork screw upper jejunum,jejunum, indicative ofindicative of volvulus withvolvulus with partial obstructionpartial obstruction
  • 21. outcomeoutcome The outcome of patients undergoingThe outcome of patients undergoing LaddLadds procedure for isolateds procedure for isolated malrotation is very good and themalrotation is very good and the majority make a full recovery. Themajority make a full recovery. The commonest postoperativecommonest postoperative complication is adhesioncomplication is adhesion obstruction occurs in 45obstruction occurs in 4565% of65% of children with malrotation and stillchildren with malrotation and still carries a mortality rate of 7carries a mortality rate of 715%;15%; necrosis of more than 75% of thenecrosis of more than 75% of the midgut short bowel syndromemidgut short bowel syndrome
  • 22. Meconieum IleusMeconieum Ileus symptoms include abdominalsymptoms include abdominal distension (96%), biliousdistension (96%), bilious vomiting (50%) and delayedvomiting (50%) and delayed passage From a clinical point ofpassage From a clinical point of view, it is possible to recognizeview, it is possible to recognize two different conditions:two different conditions: a simple, uncomplicated anda simple, uncomplicated and non-surgical type, andnon-surgical type, and a complicated, severe type, witha complicated, severe type, with a mortality of at leasta mortality of at least 25%