Common pediatric surgical conditions By Dr Hatem ElGohary

Common Pediatric Surgical Disorders

Dr. Hatem ELGoharyLecturer of General Surgery

Helwan University

Thermoregulation

less subcutaneous fat – wide surface area – immature peripheral vasomotor mechanisms.

Action:

Warm IV fluids – Warm theater – Insulate child

Pediatric Problems

Gastro-oesophegeal Reflux and AspirationAction: Naso-gastric tube

Infection Immature immune system

Action: Antiseptic conditions – proper Antibiotics.

Clotting disordersAction: Preoperative intramuscular vit. K

Gentle. In Warm Theater. Under Antiseptic condition. Bipolar Diathermy. Absorbable fine sutures.

Surgery Must Be:

Empty ScrotumCauses

Arrested along its normal pathwayof descent.

1.Undescended testis

typically present in the scrotum in earlyinfancy ;

it can be manipulated into the bottom of the scrotum without tension but tends to be pulled up by the cremastermuscle. With time, the testis resides permanently in the scrotum;however, follow-up is advisable as, rarely, the testis subsequentlyascends into the inguinal canal.

2.Retractile testis

lies outside its normal line of descent, most often in the perineum or femoraltriangle. An undescended testis may be palpable in the groin or at the neck of the scrotum or it may be impalpable if absent orlocated in the abdomen or inguinal canal.

3.Ectopic testis

Investigations

Ultrasound inguinal and femoral region Laparoscopy

Hormonal in bilateral impalpable testis to detect testosterone rise after IM HCG

Empty ScrotumRisk

Fertility. To optimise spermatogenesis the testis needs to be in the scrotum below body temperature at a young age.

Malignancy. Undescended testes are histologically abnormal

and at an increased risk of malignancy .

Cosmetic and psychological. In an older boy a prosthetic testiscan be inserted to replace an absent one.

Treatment

Orchidopexy is usually undertaken as a day-case procedure. Thetestis is mobilised through an inguinal incision, preserving the vasdeferens and testicular vessels. The associated patent processusvaginalis is ligated and divided and the testis is placed in asubdartos scrotal pouch .

Orchidectomy is often unilateral intra-abdominal testis, which cannot be corrected byorchidopexy because of the future risk of malignancy. In cases ofbilateral intra-abdominal testes, microvascular transfer andstaged orchidopexy are two options available to preserve thetestes if the testicular vessels are too short to permit a single-stage orchidopexy.

Infantile hypertrophic pyloric stenosis

Acquired disorder, hypertrophy of the circular muscle layer increases the length and diameter of the pylorus.

More in Boys between 2 to 8 weeks.

Definition

Symptoms: Non billious vomiting at the end of the feed.

Signs:.Visible gastric peristalsis from left to right..Olive-tumour felt in the epigastrium to the

right hypochondrium.

U/S: shows the thickened pyloric muscle.

Diagnosis

1. Rehydration

2. Correction of electrolytes imbalance

3. Ramstedt’s pyloromyotomy

Treatment: