Page 7 - Pediatric surgery_watermark

- Gastroenteritis - Feeding problems
Differential - Gastro-oesophageal reflux - Intestinal obstruction - Other causes of neonatal vomiting
diagnosis
** is required only if the olive tumour is not palpable.

Ultrasound:
- This is the imaging modality of choice. - CHPS is diagnosed if the thickness of the pyloric muscle is more than 4 mm.
Barium meal:
Investigations is performed if the facilities and experience in paediatric ultrasound are not available. The radiological features are:
Imaging

- Dilated stomach.
- Exaggerated peristalsis.
- The pyloric canal is elongated and narrow
- Delayed gastric emptying
Laboratory (serum electrolytes)
Investigations
These are crucial to assess electrolyte deficits as these babies usually suffer from hypochloraemia, hyponatraemia, hypokalaemia and alkalosis.
- Treatment is surgical. - It requires proper preoperative preparation.

Preoperative • Correction of dehydration and electrolyte deficits by IV fluids before surgery.
care • Stop oral feeding.
( It usually takes 24 hours to rehydrate the baby to be fit for surgery )

*** Ramstedt pyloromyotomy
Treatment
Operation • General anaesthesia.
• The abdomen is entered through a small transverse right upper abdominal incision.
• The hyperertrophied pylorus is grasped between index & thumb and a myotomy is performed until the mucosa of the pylorus bulges.
• If the mucous membrane is injured, the injury should be sutured and reinforced by an omental patch.
Post-operative care Oral feeding can be resumed after a few hours
Prognosis The results of this operation are excellent and the mortality should be around zero.