ACUTE ACUTE ABDOMENABDOMEN

ACUTE APPENDICITISACUTE APPENDICITIS

Appendicitis USAppendicitis US

Appendicitis USAppendicitis US

Appendicular Abscess with FaecolithAppendicular Abscess with Faecolith

Faecolith in plain x-rayFaecolith in plain x-ray

NB; NB; fecolithfecolith is a classic is a classic way of explaining the way of explaining the pathophysiology of pathophysiology of appendicitis, although appendicitis, although it is not the most it is not the most common..common..

Most common being Most common being hypertrophied hypertrophied lymphoid tissuelymphoid tissue obstructing the lumen.obstructing the lumen.

What is the most common DDx of What is the most common DDx of appendicitis in pediatric?appendicitis in pediatric?

M & MM & M

Mesentric adenitis Mesentric adenitis medical observant medical observant mngmntmngmnt

Meckel’s diverticulitis Meckel’s diverticulitis medically unless a medically unless a surgical indication as perforation , unrelieved surgical indication as perforation , unrelieved

obstruction, or uncontrollable bleeding obstruction, or uncontrollable bleeding

US INTUSSUSCEPTIONUS INTUSSUSCEPTION

IntussuscepIntussuscepiensiens goes into intussuscep goes into intussusceptumtum

US signs:US signs:

Doughnut / target sign-Doughnut / target sign- cross cross sectionalsectional

Pseudokidney sign -Pseudokidney sign - longitudinal longitudinal

Barium contrast enema:Barium contrast enema:

Coiled spring signCoiled spring sign

BARIUM ENEMABARIUM ENEMA

BARIUM REDUCTIONBARIUM REDUCTION

INTUSSUSCEPTIONINTUSSUSCEPTION

intussusceptumintussusceptum

intussuscepiensintussuscepiens

-Most common cause of SIO in < 2yMost common cause of SIO in < 2y- terminal ileum ( ileocecal valve) is the terminal ileum ( ileocecal valve) is the common sitecommon site- s/s: bilious vomiting/ currant jelly stool = s/s: bilious vomiting/ currant jelly stool = bloody diarrhea / dance’s sign ( retraction of bloody diarrhea / dance’s sign ( retraction of RLQ) / RUQ mass.RLQ) / RUQ mass.- Rx: -resuscitation Rx: -resuscitation

-air ( pneumatic reduction) or barium -air ( pneumatic reduction) or barium enema 85% goodenema 85% good

- if failed - if failed laparotomy ( reduction by laparotomy ( reduction by manual milking of the ileum from the colon)manual milking of the ileum from the colon)

MIDGUT VALVULUSMIDGUT VALVULUS

MIDGUT VALVULUSMIDGUT VALVULUS

MALROTATION/LADD’S BANDMALROTATION/LADD’S BAND

UPPER GIT STUDY FOR UPPER GIT STUDY FOR MALROTATIONMALROTATION

-Cecum will be in the RUQCecum will be in the RUQ RUQ mass RUQ mass - sudden onset of bilious vomiting in infant sudden onset of bilious vomiting in infant (< 1yr) is (< 1yr) is malrotationmalrotation until proven until proven otherwise.otherwise.-Complication: volvulus / midgut infarctionComplication: volvulus / midgut infarction-Rx: -IV Abx & resuscitation with RL Rx: -IV Abx & resuscitation with RL

- Ladd’s procedure : - Ladd’s procedure : counterclockwise reduction, counterclockwise reduction, cutting the band, division of peritoneal attachment of cecum & ascending cutting the band, division of peritoneal attachment of cecum & ascending colon, appendectomy.colon, appendectomy.

MECKEL’S DIVERTICULUMMECKEL’S DIVERTICULUM

MECKEL’S DIVERTICULUMMECKEL’S DIVERTICULUM

-true diverticulum-true diverticulum-DDx of appendicitisDDx of appendicitis-Rule of 2:Rule of 2:

-2% symptomayic-2% symptomayic

-2 feet (61 cm) from the ileocecal -2 feet (61 cm) from the ileocecal valvevalve

- majority before 2 y- majority before 2 y

- 2% of population- 2% of population

-2 inches (5 cm) long -2 inches (5 cm) long

- male : female 2:1- male : female 2:1

- 2 ectopic tissues: gastric, pancreatic- 2 ectopic tissues: gastric, pancreatic

Complications:Complications:

HemorrhageHemorrhage (painless): common in <2y (painless): common in <2y

50% ( due to ulceration of gastric tissue)50% ( due to ulceration of gastric tissue)

ObstructionObstruction :common in adult 25% :common in adult 25%

Inflamation Inflamation (Meckle’s diverticulitis) (Meckle’s diverticulitis) 20% 20% pain mimicking appendicitis.pain mimicking appendicitis.

OVARIAN TORSIONOVARIAN TORSION--adolescent girl with acute severe abdominal pain adolescent girl with acute severe abdominal pain

--Dx by US Dx by US Rx:Rx: laparoscopy or laparotomy laparoscopy or laparotomy

-derotate-derotate-Fix both sides -Fix both sides

-or remove if necrotic-or remove if necrotic

Pneumoperitonium Pneumoperitonium

--occurs as a result of perforation of any occurs as a result of perforation of any viscusviscus-we know it by the presence of free air -we know it by the presence of free air under the diaphragm in an erect filmunder the diaphragm in an erect film

NECNEC( necrotising enterocolitis)( necrotising enterocolitis)

-it is an ER-it is an ER

We see fixed dilated We see fixed dilated intestinal intestinal loops ,loops ,pneumatosis pneumatosis intestinalis ( air in intestinalis ( air in the bowel wal)the bowel wal)

- Portal vein air in - Portal vein air in advanced disease .advanced disease .

--PrematurityPrematurity is predisposing factor. is predisposing factor.

--most common cause of ER laparotomy in most common cause of ER laparotomy in neonateneonate

-s/s: distention, vomiting, rectal -s/s: distention, vomiting, rectal bleeding ,fever , hypothermia, jaundice , bleeding ,fever , hypothermia, jaundice , erythema of abdomen- peritonitiserythema of abdomen- peritonitis

-Rx: medically( no feeding , OG tube, IV -Rx: medically( no feeding , OG tube, IV fluids & Abx ,ventilator support)fluids & Abx ,ventilator support)-Indication of surgery:Indication of surgery:

1-free air (perforation)1-free air (perforation)

2-+ve peritoneal tap 2-+ve peritoneal tap