ACUTE ABDOMEN

ACUTE APPENDICITIS

US OF APPENDICITIS

Appendicitis US

Appendicular Abscess with Faecolith

Faecolith in plain x-ray NB; fecolith is a classic way of explaining the pathophysiology of appendicitis, although it is not the most common.. Most common being hypertrophied lymphoid tissue obstructing the lumen.

What is the most common DDx of appendicitis in pediatric? M & M Mesentric adenitis  medical observant mngmnt Meckel’s diverticulitis  medically unless a surgical indication as perforation, unrelieved obstruction, or uncontrollable bleeding

US INTUSSUSCEPTION

Intussuscepiens goes into intussusceptum US signs: Doughnut / target sign-  cross sectional Pseudokidney sign -  longitudinal Barium contrast enema: Coiled spring sign

BARIUM ENEMA BARIUM ENEMA

BARIUM REDUCTION

INTUSSUSCEPTION intussusceptum intussuscepiens

- Most common cause of SIO in < 2y - terminal ileum ( ileocecal valve) is the common site - s/s: bilious vomiting/ currant jelly stool = bloody diarrhea / dance’s sign ( retraction of RLQ) / RUQ mass. - Rx: -resuscitation -air ( pneumatic reduction) or barium enema 85% good -air ( pneumatic reduction) or barium enema 85% good - if failed  laparotomy ( reduction by manual milking of the ileum from the colon) - if failed  laparotomy ( reduction by manual milking of the ileum from the colon)

MIDGUT VALVULUS

MALROTATION/LADD’S BAND

UPPER GIT STUDY FOR MALROTATION

- Cecum will be in the RUQ  RUQ mass - sudden onset of bilious vomiting in infant (< 1yr) is malrotation until proven otherwise. - Complication: volvulus / midgut infarction - Rx: -IV Abx & resuscitation with RL - Ladd’s procedure : counterclockwise reduction, cutting the band, division of peritoneal attachment of cecum & ascending colon, appendectomy. - Ladd’s procedure : counterclockwise reduction, cutting the band, division of peritoneal attachment of cecum & ascending colon, appendectomy.

MECKEL’S DIVERTICULUM

-true diverticulum - DDx of appendicitis - Rule of 2: -2% symptomayic -2% symptomayic -2 feet (61 cm) from the ileocecal valve -2 feet (61 cm) from the ileocecal valve - 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: Hemorrhage (painless): common in <2y Hemorrhage (painless): common in <2y 50% ( due to ulceration of gastric tissue) 50% ( due to ulceration of gastric tissue) Obstruction :common in adult 25% Obstruction :common in adult 25% Inflamation (Meckle’s diverticulitis) 20%  pain mimicking appendicitis. Inflamation (Meckle’s diverticulitis) 20%  pain mimicking appendicitis.

OVARIAN TORSION -adolescent girl with acute severe abdominal pain -Dx by US Rx: laparoscopy or laparotomy -derotate -Fix both sides -or remove if necrotic

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

NEC ( necrotising enterocolitis) -it is an ER We see fixed dilated intestinal loops,pneumatosis intestinalis ( air in the bowel wal) - Portal vein air in advanced disease.

-Prematurity is predisposing factor. -most common cause of ER laparotomy in neonate -s/s: distention, vomiting, rectal bleeding,fever, hypothermia, jaundice, erythema of abdomen- peritonitis -Rx: medically( no feeding, OG tube, IV fluids & Abx,ventilator support) - Indication of surgery: 1-free air (perforation) 1-free air (perforation) 2-+ve peritoneal tap 2-+ve peritoneal tap