Pediatric surgeryClinical practice

DR. Bassam Al-Abbasi

الدكتور من الصور

الطالب كتابة من الشرح

Head and Neck

Cleft lip and palateProblems: • 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 hygromaNotes: • 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 tumor2- Neuroblastoma3- Neglected PUJ obstruction

Presentation: 1- Mass2- hematuria3- hypertension

Treatment by surgery remove the kidney + chemotherapy

Neuroblastoma in the adrenal gland

Diagnosis: non-Hodgkin lymphoma

Presentation: 1- Mass2- Intussusception

Investigation: FNA

Treatment: surgery + chemotherapy (for one year)

Diagnosis: Sacro-coccygeal teratoma

Problems: 1-obstructed labor2- Malignancy (if neglected for 2-3 months)

Treatment: surgery + remove the coccyx to prevent recurrence

Spleen, Pancreas and Biliary Tractمطلوب غير

مطلوب غير

First photo: Diagnosis: rectal prolapseCauses: • Constipation or diarrhea• Weak pelvic muscles • Worm (trichuris trichiura)Grades: • Grade1 ويرجع conservative treatment by taping يطلع• Grade2 للدخول دفع الى ويحتاج surgery (Therach operation) يطلع• Grade3 ابد يرجع وما surgery (Therach operation) يطلع

Second photo: Diagnosis: Perianal fistula Treatment: surgery (fistulectomy or fistulotomy)

Third photo: Diagnosis: rectal polypCause 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

مطلوب غير

مطلوب غير

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