Pyloric Stenosis
This is a condition where the pylorus, the muscle at the outlet of the stomach, thickens and narrows. This blocks food from emptying out of the stomach into the small intestine.

• Typically presents in infants, usually between 2 and 8 weeks of age.

• Hallmark symptom is forceful, projectile vomiting (non-bilious, meaning it doesn’t contain bile) that occurs shortly after feeding.

• Other signs include persistent hunger despite vomiting, poor weight gain or weight loss, dehydration, and sometimes an olive-shaped mass palpable in the upper abdomen.

• Diagnosis is often confirmed by abdominal ultrasound.

• Management involves initial correction of dehydration and electrolyte imbalances, followed by a surgical procedure called pyloromyotomy, which involves cutting the thickened pyloric muscle to relieve the obstruction.

Intussusception
This is a condition where one segment of the intestine “telescopes” into an adjacent segment, like parts of a collapsible telescope folding into one another. This can obstruct the bowel and cut off its blood supply.

• Most common abdominal emergency in early life, typically occurring between 3 months and 3 years of age.

• Classic triad of symptoms includes sudden onset of intermittent, severe, colicky abdominal pain (causing the individual to draw up their legs), a palpable sausage-shaped abdominal mass, and “currant jelly” stools (stools mixed with blood and mucus). Vomiting (often bilious) and lethargy are also common.

• Diagnosis can be suggested by clinical presentation and confirmed by abdominal ultrasound or air/contrast enema.

• Management: Non-operative reduction using a therapeutic air or contrast enema is often successful. If this fails, or if there are signs of peritonitis or bowel perforation, surgical reduction or resection of the affected bowel segment is necessary.

Appendicitis
This means inflammation of the appendix, a small, finger-like pouch attached to the large intestine.

• Can occur at any age, but is less common in very young individuals.

• Symptoms typically begin with periumbilical pain (around the navel) that later migrates to the right lower quadrant of the abdomen. Other signs include nausea, vomiting, loss of appetite, fever, and localized tenderness (especially at McBurney’s point).

• Diagnosis is based on clinical examination, laboratory tests (e.g., elevated white blood cell count), and often imaging studies like ultrasound or CT scan.

• Management is surgical removal of the appendix (appendectomy), which can be done via an open incision or laparoscopically. Prompt surgery is important to prevent rupture, which can lead to peritonitis.

Hirschsprung’s Disease (Congenital Aganglionic Megacolon)
This is a congenital condition where nerve cells (ganglion cells) are missing from a segment of the bowel, most commonly the rectum and sigmoid colon. This lack of nerve cells prevents normal muscle contractions (peristalsis), leading to a functional bowel obstruction.

• Symptoms often present in the newborn period with failure to pass meconium within the first 24-48 hours of life, abdominal distension, bilious vomiting, and reluctance to feed. In older individuals, it can present as chronic constipation, foul-smelling ribbon-like stools, and poor growth.

• Diagnosis is suspected clinically and confirmed by rectal biopsy showing the absence of ganglion cells. A contrast enema may show a transition zone between the narrowed aganglionic segment and the dilated, normal bowel proximal to it.

• Management is surgical. This typically involves a “pull-through” procedure where the aganglionic segment of the colon is removed, and the healthy ganglionic bowel is brought down and anastomosed (connected) to the anus. This may be done in one or multiple stages, sometimes requiring a temporary colostomy.

Inguinal Hernia / Hydrocele

• Inguinal Hernia: This occurs when a portion of the intestine or other abdominal contents protrudes through a weakness or opening (the processus vaginalis) in the abdominal wall in the groin area.

  • Presents as a bulge in the groin or scrotum, which may be more noticeable when crying, coughing, or straining, and may retract when relaxed or lying down.

  • Risk of incarceration (hernia becomes trapped and cannot be reduced) or strangulation (blood supply to the trapped tissue is cut off), which is a surgical emergency.

  • Management is surgical repair (herniorrhaphy) to close the opening, usually performed electively.

• Hydrocele: This is a collection of fluid in the sac surrounding the testicle (tunica vaginalis), causing swelling in the scrotum.

  • Common in newborns due to a patent processus vaginalis allowing peritoneal fluid to enter the scrotum. Most communicating hydroceles resolve spontaneously within the first year or two of life as the processus vaginalis closes.

  • Non-communicating hydroceles can occur at any age due to imbalance of fluid secretion and absorption.

  • Presents as a painless scrotal swelling, often transilluminates (light passes through it).

  • Management for communicating hydroceles that persist beyond 12-18 months, or for large or symptomatic hydroceles, is surgical repair similar to an inguinal hernia repair.

Undescended Testes (Cryptorchidism)
This refers to the failure of one or both testes to descend from the abdomen, where they develop, into the scrotum before birth or in the early months after birth.

• The testes may be located anywhere along the normal path of descent (e.g., abdomen, inguinal canal) or in an ectopic location.

• Important to distinguish from retractile testes, which are normally descended but can be pulled up into the inguinal canal by an overactive cremasteric reflex.

• Undescended testes are associated with increased risks of infertility, testicular cancer, testicular torsion, and inguinal hernias.

• Management: Many undescended testes will descend spontaneously within the first few months of life. If a testis remains undescended by 6 months of age (corrected for prematurity), surgical correction (orchiopexy) is typically recommended, usually performed between 6 and 18 months of age. This involves surgically bringing the testis down into the scrotum and securing it.

Cleft Lip and Cleft Palate
These are congenital facial malformations that occur when the tissues forming the lip and/or palate (roof of the mouth) do not fuse properly during fetal development.

• Cleft Lip: A split or opening in the upper lip. Can be unilateral (one side) or bilateral (both sides), and can range from a small notch to a complete separation extending into the nose.

• Cleft Palate: An opening in the roof of the mouth. Can involve the soft palate (back of the roof of the mouth), the hard palate (bony front part), or both. It can occur with or without a cleft lip.

• Can cause difficulties with feeding (inability to create adequate suction), speech problems, ear infections (due to Eustachian tube dysfunction), and dental issues.

• Management is multidisciplinary, involving surgeons, orthodontists, speech therapists, audiologists, and others. Surgical repair is the primary treatment:

  • Cleft lip repair (cheiloplasty) is usually performed around 3-6 months of age.

  • Cleft palate repair (palatoplasty) is typically done between 9 and 18 months of age, often before significant speech development.

  • Further surgeries may be needed as the individual grows.

Tracheoesophageal Fistula (TEF) / Esophageal Atresia (EA)
These are congenital defects where the esophagus (the tube connecting the mouth to the stomach) and the trachea (windpipe) do not form correctly.

• Esophageal Atresia (EA): The esophagus is interrupted and does not form a continuous passage to the stomach. The upper esophagus often ends in a blind pouch.

• Tracheoesophageal Fistula (TEF): There is an abnormal connection between the esophagus and the trachea.

• Several types exist, the most common being EA with a distal TEF (upper esophagus ends in a blind pouch, and the lower esophagus connects to the trachea).

• Signs in a newborn include excessive drooling or salivation (the “3 Cs”: coughing, choking, and cyanosis) especially with attempts to feed, respiratory distress, and inability to pass a nasogastric tube into the stomach. Aspiration pneumonia is a major risk.

• Diagnosis is confirmed by inability to pass a catheter into the stomach and chest/abdominal X-rays (which may show the catheter coiled in the esophageal pouch and air in the stomach if a distal TEF is present).

• Management is surgical emergency. It involves ligating (tying off) the fistula and repairing the esophagus, often by primary anastomosis (joining the two ends of the esophagus). If the gap between esophageal segments is too large, staged repairs may be necessary. Pre-operative care focuses on preventing aspiration.

Omphalocele / Gastroschisis
These are congenital abdominal wall defects where abdominal organs protrude outside the body.

• Omphalocele: Abdominal organs (e.g., intestines, liver, spleen) herniate through the umbilical ring and are covered by a membranous sac (peritoneum and amnion). The umbilical cord inserts onto the sac. Often associated with other congenital anomalies.

• Gastroschisis: Abdominal organs (usually intestines) protrude through a full-thickness defect in the abdominal wall, typically to the right of an intact umbilical cord. The organs are not covered by a sac and are exposed directly to amniotic fluid.

• Both are usually diagnosed prenatally via ultrasound.

• Management is surgical.

  • Initial management focuses on protecting the exposed organs (e.g., covering with sterile, moist dressings or a bowel bag), preventing heat and fluid loss, preventing infection, and decompressing the bowel.

  • Surgical repair involves returning the organs to the abdominal cavity and closing the abdominal wall defect. This may be done in a single stage (primary closure) if possible, or in stages (staged closure), often using a silo to gradually reduce the organs back into the abdomen if the abdominal cavity is too small.

Volvulus (Malrotation with Midgut Volvulus)
This is a life-threatening surgical emergency caused by malrotation of the intestine during fetal development. Malrotation means the intestines do not rotate and fixate in their normal positions in the abdomen. This leaves the intestine prone to twisting around its blood supply (volvulus), leading to bowel obstruction and ischemia (lack of blood flow), which can rapidly progress to necrosis (tissue death).

• Often presents in the neonatal period, but can occur at any age.

• Key symptom is sudden onset of bilious (green or dark yellow) vomiting. Abdominal pain, distension, and signs of shock (lethargy, poor perfusion) may follow.

• Diagnosis is urgent. An upper GI contrast study is often the diagnostic test of choice, showing a “corkscrew” appearance of the duodenum or abnormal position of the duodenojejunal junction.

• Management is immediate surgical intervention (Ladd’s procedure). This involves counter-clockwise detorsion (untwisting) of the volvulus, lysis of Ladd’s bands (abnormal fibrous bands), widening the base of the mesentery, and prophylactic appendectomy (as the cecum will be in an abnormal position). If bowel is necrotic, resection may be necessary.