Pyloric Stenosis
This is a narrowing of the pylorus, the muscular opening from the stomach into the small intestine. The pyloric muscle thickens, blocking food from leaving the stomach.

• Typically seen a few weeks after birth.

• Key sign: Forceful, projectile vomiting (non-bilious, meaning no green/yellow bile) shortly after feeds. The individual remains hungry.

• Other signs: Poor weight gain, dehydration, sometimes a small, olive-shaped lump felt in the upper abdomen.

• Diagnosis: Abdominal ultrasound.

• Management: Initial correction of dehydration and electrolyte imbalance, followed by a surgical procedure called pyloromyotomy (cutting the thickened muscle).

Intussusception
This occurs when a segment of the intestine slides or “telescopes” into an adjacent part of the intestine. This can block the bowel and cut off its blood supply.

• Most common in individuals under 3 years of age.

• Signs: Sudden onset of severe, intermittent abdominal pain (causing drawing up of legs), vomiting (may become bilious), and “currant jelly” stools (stools mixed with blood and mucus). A sausage-shaped mass might be felt in the abdomen. Lethargy is common.

• Diagnosis: Ultrasound or contrast/air enema.

• Management: Often treated with a therapeutic enema (air or contrast) to push the intestine back into place. If this fails or there are signs of bowel damage, surgery is needed to reduce it manually or remove damaged bowel.

Hirschsprung’s Disease (Congenital Aganglionic Megacolon)
A condition present at birth where nerve cells (ganglion cells) are missing from a part of the large intestine, usually the rectum and sigmoid colon. This prevents normal muscle movement (peristalsis) in that segment, causing a blockage.

• Signs in newborns: Failure to pass meconium (first stool) within 24-48 hours, abdominal distension, bilious vomiting.

• Signs in older individuals: Chronic constipation, ribbon-like stools, poor growth.

• Diagnosis: Rectal biopsy (shows absence of ganglion cells), contrast enema.

• Management: Surgical removal of the affected aganglionic bowel segment and connection of the healthy bowel to the anus (pull-through procedure). May involve a temporary ostomy.

Malrotation with Midgut Volvulus
Malrotation is a congenital abnormality where the intestine doesn’t twist and fix into its normal position in the abdomen during fetal development. This makes it prone to twisting on itself (volvulus), which cuts off blood supply to the bowel.

• A surgical emergency, often presenting in the first month of life.

• Key sign: Sudden onset of bilious (green or dark yellow) vomiting.

• Other signs: Abdominal pain, distension, bloody stools, signs of shock.

• Diagnosis: Upper GI contrast study.

• Management: Immediate surgery (Ladd’s procedure) to untwist the bowel, divide abnormal bands (Ladd’s bands), widen the base of the mesentery, and usually perform an appendectomy.

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

• Can occur at any age.

• Signs: Pain often starting around the navel and then moving to the right lower abdomen, nausea, vomiting, fever, loss of appetite, tenderness in the right lower abdomen.

• Diagnosis: Clinical examination, lab tests (e.g., elevated white blood cell count), ultrasound or CT scan.

• Management: Surgical removal of the appendix (appendectomy), either open or laparoscopic. Prompt surgery prevents rupture and peritonitis.

Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)
These are birth defects where the esophagus (food pipe) and trachea (windpipe) do not form correctly.

• EA: The esophagus is not continuous, often ending in a blind pouch.

• TEF: There’s an abnormal connection between the esophagus and trachea.

• Most common type is EA with a fistula connecting the lower esophagus to the trachea.

• Signs in newborns: The “3 Cs” – Coughing, Choking, and Cyanosis (bluish skin) with feeds; excessive drooling; inability to pass a feeding tube into the stomach.

• Diagnosis: Inability to pass a nasogastric tube, chest X-ray.

• Management: Surgical emergency. Involves disconnecting the fistula and repairing the esophagus, usually by joining the two ends.

Anorectal Malformations (Imperforate Anus)
A range of birth defects where the anus and rectum (the lower end of the digestive tract) do not develop properly. The anal opening may be missing, in the wrong place, or very narrow. There may be a fistula (abnormal connection) to the urinary tract or genital tract.

• Signs: No anal opening visible, meconium passed from an abnormal location (e.g., urethra, vagina), abdominal distension.

• Diagnosis: Physical examination, X-rays, ultrasound.

• Management: Depends on the type of malformation. May involve a temporary colostomy followed by surgical reconstruction (anoplasty or posterior sagittal anorectoplasty – PSARP) to create an anal opening in the correct position. Dilatations may be needed post-surgery.

Necrotizing Enterocolitis (NEC) requiring surgery
NEC is a serious intestinal illness primarily affecting premature infants, where intestinal tissue becomes inflamed and damaged, potentially leading to death (necrosis) of the tissue.

• While initially managed medically, surgery is indicated for complications such as:

  • Bowel perforation (a hole in the intestine).

  • Clinical deterioration despite maximal medical therapy.

  • Fixed, dilated loop of bowel on X-ray.

• Signs suggesting need for surgery: Abdominal distension, tenderness, redness of the abdominal wall, signs of peritonitis, free air on abdominal X-ray (indicating perforation).

• Management: Surgical resection (removal) of the necrotic bowel and often creation of an ostomy (e.g., ileostomy or colostomy). Some cases might involve primary anastomosis (reconnecting healthy bowel ends).

Biliary Atresia
A rare condition in newborns where the bile ducts (tubes that carry bile from the liver to the gallbladder and intestine) are blocked or absent. Bile builds up in the liver, causing damage.

• Signs: Jaundice (yellowing of skin and eyes) that persists or appears after 2 weeks of age, pale stools (acholic), dark urine, poor weight gain, enlarged liver.

• Diagnosis: Blood tests, ultrasound, liver biopsy, intraoperative cholangiogram.

• Management: Surgical procedure called the Kasai portoenterostomy, ideally performed before 60-90 days of age. This connects a loop of intestine directly to the liver to allow bile to drain. Many individuals will eventually require a liver transplant even after a Kasai procedure.

Meckel’s Diverticulum
A common congenital outpouching (diverticulum) of the small intestine, present at birth. It is a remnant of the omphalomesenteric duct.

• Often asymptomatic. When symptoms occur, they can include:

  • Painless rectal bleeding (often brick-red or currant jelly-like) due to ectopic gastric or pancreatic tissue in the diverticulum causing ulceration.

  • Intestinal obstruction (due to volvulus around the diverticulum, intussusception with the diverticulum as a lead point, or entrapment in a hernia).

  • Diverticulitis (inflammation, similar to appendicitis but pain may be periumbilical or variable).

• Diagnosis: Often difficult; Meckel’s scan (technetium-99m pertechnetate scan) can detect ectopic gastric mucosa. Sometimes diagnosed incidentally during surgery for another reason.

• Management: Surgical removal (diverticulectomy or segmental bowel resection) if symptomatic or found incidentally in certain circumstances.

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