Neonatal and General paediatric Surgery
The plain abdominal x-ray shows dilated loops of intestine with an absence of gas in the rectum. A contrast enema may show a contracted rectum with dilated bowel proximally, but in the neonatal period the feature may be absent. The diagnosis may be suspected on plain abdominal x-ray by the absence of intestinal gas in the presence of bilious vomiting, especially in the neonatal period. Neonatal necrotising enterocolitis (NEC) occurs predominantly in the stressed premature infant and is one of the most common neonatal surgical emergency conditions. The first sign of the onset of NEC is reluctance of the infant to feed. The infant with respiratory distress requires urgent resuscitation and stabilisation prior to surgery. This consists of endotracheal intubation, gentle mechanical ventilation and elective sedation and paralysis. Indications for surgery are intestinal perforation, intestinal obstruction or failure to respond to conservative measures. Late indication for surgery is stricture formation.