Common Problems in Pediatric Surgery problems 04-2562.pdf · Pediatric Surgery contents for MD...
Transcript of Common Problems in Pediatric Surgery problems 04-2562.pdf · Pediatric Surgery contents for MD...
Common Problems in Pediatric Surgery
Paisarn Vejchapipat, MD PhD FACSPediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University
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Chula Pediatric Surgery Website
www.pedsurgery.md.chula.ac.th
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Pediatric Surgery contents for MD Basic knowledge
Head & Neck lesions
Diaphragm & lungs
GIT newborn
GIT infants & children
Biliary diseases
Abdominal wall
Inguinal and genitalia
Tumors
Trauma
Common Problems
OPD cases
IPD cases
Pediatric Surgery: OPD
Tongue tie Dermoid cyst Preauricular sinus 2nd Branchial cleft cyst Thyroglossal duct cyst Cystic hygroma Torticollis
Pediatric Surgery: OPD
Umbilical hernia Indirect inguinal hernia Hydrocele Undescended testis Labial fusion Phimosis Hypospadias Buried penis
Umbilical hernia
Most patients have spontaneous closure before 3 years of age
Treatment: umbilicoplasty if persistent after 3 years
Indirect inguinal hernia
Indirect inguinal hernia
Treatment: herniotomy
Lap hernia repair
Hydrocele
Hydrocele with ascites
Hydrocele of spermatic cord
Treatment
Communicating hydrocele
Non-communicating hydrocele
Hydrocele of cord
Vaginal hydrocele
Processus vaginalis ligation
Spontaneous resolution (within 2 years),
If not hydrocelectomy
Undescended Testis
D/Dx Undescended testis Retractile testis Ectopic testis Testicular atrophy Anorchia
Retractile testis
Ectopic testis
Untreated undescended testis
Possibility of indirect inguinal hernia Risk of testicular torsion Risk of infertility Malignant potentials Prone to trauma Psychological aspects
Treatment for undescended testis
Orchiopexy Inguinal testis Intra-abdominal testis Ectopic testis
Torsion of Testis
Phimosis and Posthitis
Paraphimosis
Paraphimosis
Indications for circumcision
Pathologic phimosis Paraphimosis Posthitis Preputial “pearls” Redundant foreskin Prevention of UTI Trauma Religious belief
Common Problems at IPD GI anomalies
Esophageal atresia Hypertrophic pyloric stenosis Duodenal atresia Jejuno-ileal atresia Malrotation Hirschsprung’s disease Imperforate anus
Abdominal wall defects
Congenital Abdominal Wall Defect
Gastroschisis Omphalocele
Embryology
GASTROSCHISIS Vascular accident Congenital weakening
OMPHALOCELE Failure of migration
and fusion of embryonic folds; cephalic, caudal, lateral folds
Epidemiology GASTROSCHISIS
Young maternal age Low socioeconomic Use of aspirin, Ibuprofen,
pseudoephridine
OMPHALOCELE 30% chromosomal
anomaly; trisomy 13, 18
Over all incidence ~ 1:3000 live birth
Associated Anomalies GASTROSCHISIS
15% Malrotation Intestinal atresia
OMPHALOCELE 50-80% other
malformations; Cardiac, Genitourinary Musculoskeletal Beckwith-Weidemann
syndrome Neural tube malformation Pentalogy of Cantrell
Cesarean Section
No evidences to decrease incidence of bowel injury, birth injury, or infection
Recommended in giant omphalocele
Giant Omphalocele
Omphalocele 3 layers sac coverage
Peritoneum, Wharton’s jelly, amnion
Early management same as Gastroschisis Require less fluid resuscitation
Initial evaluation of other malformations
Treatment dependent on SIZE of the lesion
Prognosis dependent on associated anomalies
Treatment
Early management 1. Sterile protection
2. Hypothermia prevention
3. Adequate fluid resuscitation
4. Antibiotic administration
Initial management
Initial management
Abdominal closure
Primary fascial closure
Artifical sac closure
Skin flap closure
Non-operative management (for omphalocele)
Primary fascial closure
Artificial sac closure
Artificial sac closure
Artificial sac closure
Artifical sac closure
Artificial sac closure
Skin flap closure
Non-operative treatment (for omphalocele)
Conclusions Common problems in pediatric surgery
OPD casesIPD cases
Understanding of these conditions is essential for the prognosis of these babies