DR. ZAINAB AL BALUSHIMD,FRCSC, FICSSENIOR CONSULTANT PEDIATRIC SURGERY SULTAN QABOOS UNIVERSITY HOSPITAL,OMAN Paediatric SurgeryEmergencies

CHILDREN ARE DIFFERENT!

Larger surface area to mass ratioLess SQ fatMore body waterHigher metabolic rateThermoregulation

FLUID BALANCE

Maintenance Fluid Requirement:

0 10 Kg ---> 4 ml/Kg/hr10 20 Kg ---> 2ml/Kg/hr20+ Kg ---> 1 ml/Kg/hrAdequate urine output: 1 2 mls/Kg/hourCirculating volume:85 ml/kg

Perianal Conditions

Neck Conditions

Thyroglossal Duct Cyst / Dermoid

Midline neck massesBoth require excisionTGDC can become infected (rare for Dermoids)

Groin conditions

Hernia or Hydrocele?

Both due to patent processus vaginalisHydroceles:transilluminate palpate the cord above it often cant feel the testis Hernias: can be reduced painful if incarcerated

Hernia or Hydrocele?

Hernia or Hydrocele?

Unilateral Frog-Leg Maneuver

In a female consider the possibility of an incarcerated ovary

Acute Scrotum

Testicular torsionTwisting of testis around spermatic cordCaused by abnormal fixation of testis to scrotumVascular supply compromised

Acute painful scrotal swellingSevere tendernessRedness or dusky colorTestis elevatedCremasteric reflex absent

!SURGICAL EMERGENCY

TorsionR. testis: blood flow (Doppler)L. testis: lack of blood flowThe consequence of delayed diagnosis6 hour window for surgical detorsion

ManagementImmediate surgical consultation is essential .

Surgical exploration , detorsion and fixation.

Vomiting in children

PYLORIC STENOSIS

Male:Female 4:1Age 2 6 weeksForceful nonbilious vomiting (projectile)Dx: Palpation of massUltrasoundUGI contrast study

DiagnosisUGI

Delayed passage of barium through thickened pyloric channelUltrasoundThickened, elongated pyloric channel

Resuscitation

Correction of dehydrationCorrection of Hypochloremic metabolic alkalosisRamstedt Pyloromyotomy

INTUSSUSCEPTION

Age 2 months to 2 years Recent viral illnessIntermittent severe visceral pain (cramps)Blood PR => Currant jelly stoolEventually will develop a distal bowel obstruction

Currant jelly stool

Donut sign

Contrast Enema

Incomplete Air Reduction

BEWARE THE BABY WHO VOMITS BILE !!!!

MALROTATION / VOLVULUSMalrotation leads to nonfixation of the bowel, which predisposes to volvulus

Arrest of rotation after 90 degrees (270 normal)

1st yr of life

UGIDuodenal-jejunaljunction

Hirschsprungs Disease

Transition Zone

In SummaryDo not incise Peri-anal abscess in neonateDo not confuse Infected Thyroglossal cyst with Neck abscessDo not miss acute scrotal conditionsBilious vomiting is always serious in children

Take home messageChildren are the heart and best resource of our future. So, Let us try our best to develop and promote innovative and sustainable community resources that nurture healthy children, healthy families and healthy communities.

Thanks