Pediatric surgery practical

Pediatric surgeryClinical practice

DR. Bassam Al-Abbasi

الصور من الدكتورالشرح من كتابة الطلاب

Head and Neck

Cleft lip and palate

Problems:
• Aspiration during feeding
• Nasal speech
• Cosmetic problems
• Affect the hearing (glue ear)
• Lead to recurrent chest infection
Surgery:
• In 6 months to 1 year for cleft palate
• In 3 months for cleft lip


Feeding:
• Use special bottle tit
• In setting position

Cleft lip repair (cheiloplasty)

First photo:

Diagnosis: thyroglossal cyst
Problems:
• Lead to infection
• Lead to fistula
• Could convert to malignancy


Need surgery  remove the fistula tract + remove the hyoid bone to
prevent recurrance

Second photo:

Diagnosis: cystic hygroma
Notes:
• It is due to lymphatic obstruction
• Common at the sites of communication between the trunk and the extremities
like cervical region, axilla, groin.
Treatment:
• By surgery: it depends on presence of complications like compression, infection
bleeding (rapid increase in size and become pale and shock)
• During surgery be careful to some nerves like hypoglossal never, spinal
accessory nerve, mandibular branch of facial nerve

Diagnosis:

sternocleidomastoid torticollis (first photo)
sternocleidomastoid mass (second photo)

Notes:

• Ask about breech presentation and obstructed labor
• If not treat the mass it could be converted to torticollis
• Treatment of mass is by physiotherapy by twisting the chin and movement of
ear and massage  90% will disappear  if not treated do surgery by
cutting the mass and muscle.
• Treatment of torticollis is by surgery.








First photo:
Diagnosis: External angular dermoid

Notes:

• Treated by surgery  excision and complete remove
• Problems  infection, trauma, cosmetic
Second photo:
Diagnosis: remnant of second branchial arch  branchial cyst or fistula

Site: anterior border of sternocleidomastoid muscle between tonsil

and lower two third of sternocleidomastoid muscle

Problems: infection – malignancy

Treatment: surgery (excision)

The Umbilicus

First photo:

Diagnosis: umbilical hernia

Treatment: could resolve spontaneously or by surgery

Second photo:
Omphalo-mesenteric duct  connection between umbilicus and bowel

Diagnosis: Michaels diverticulum

Role of 2:
• 2% of population.
• 2 type of mucosa(ectopic gastric mucosa).
• 2 feet from iliocecal valve.
• 2 inches in lengthe.


Presentation:
• Bleeding per rectum (painless – bright red – profuse)
• Infection (lead to abdominal pain)
• Complication  intestinal obstruction, volvulus, intussusception
• Incidental finding

Diagnosis:

• Use isotope (bind to gastric tissue (parietal cell) within the mechaels)
• Laparoscope (diagnostic and therapeutic)

Vomiting in the First Months of Life

Diagnosis: pyloric stenosis

Presentation:
• Projectile vomiting (not present in first two weeks)
• Olive mass in the abdomen
• Positive prestalsis
• FTT
Diagnosis:
• Clinically
• Ultrasound
• Ba-meal  dilated stomach – failure to pass to intestine – string sign


Treatment: surgery  pyloromyotomy (rami stick surgery)

Diagnosis: achalasia cardia

Presentation:
• Hailtosis
• Vomiting (not projectile)
• Wheezing
• Chest infection
Ba-swallow  dilatation of esophagus with narrowing of lower part.

Treatment  cardiomyotomy

The Child with an Abdominal Mass

5 years child, presented with mass in the flank.

DDx of mass in the flank:
1- Wilms tumor
2- Neuroblastoma
3- Neglected PUJ obstruction

Presentation:

1- Mass
2- hematuria
3- hypertension

Treatment by surgery  remove the kidney + chemotherapy

Neuroblastoma in the adrenal gland

Diagnosis: non-Hodgkin lymphoma

Presentation:
1- Mass
2- Intussusception

Investigation: FNA

Treatment: surgery + chemotherapy (for one year)

Diagnosis: Sacro-coccygeal teratoma

Problems:
1-obstructed labor
2- Malignancy (if neglected for 2-3 months)

Treatment: surgery + remove the coccyx to prevent recurrence

Spleen, Pancreas and Biliary Tract

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First photo:

Diagnosis: rectal prolapse
Causes:
• Constipation or diarrhea
• Weak pelvic muscles
• Worm (trichuris trichiura)
Grades:
• Grade1  يطلع ويرجع  conservative treatment by taping
• Grade2  يطلع ويحتاج الى دفع للدخول  surgery (Therach operation)
• Grade3  يطلع وما يرجع ابد  surgery (Therach operation)
Second photo:
Diagnosis: Perianal fistula
Treatment: surgery (fistulectomy or fistulotomy)
Third photo:
Diagnosis: rectal polyp
Cause in infection
Red-bleed mass + bleeding per rectum
Treatment: excision (use sigmoidoscope)

Hernia

Varicocele

Diagnosis: undescended testes

Problems:
• Tumor
• Sterility
• Infection
• Orchitis (like appendicitis)
Treatment:
• If palpable  do fixation
• If not palpable  do laparoscopy
• If not present  do nothing

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ANY QUESTIONS