Childhood Surgery Flashcards
Rectal prolapse in children
Mostly secondary to constipation- treat with laxatives
Occasionally injection of sclerosant - rarely a thiersch procedure
Treatment for duodenal atrasia
Duodenoduodenostomt
Cryptorchidism (congenital undescended testis)
Fail to descend by 3 months - normally down by 6 months
Linked to:
Patent processus vaginalis
Abnormal epididymis
Cerebral palsy
Mental retardation
Wilms tumour
Abdominal wall defects (e.g. gastroschisis, prune belly syndrome)
Treatment is orchidopexy at 6-18minths
Intestinal malrotstion
Mid gut volvulus-
US the SMA lies to the left of the SMV in normal anatomy)
In upper GI contrast series the DJ flexure is normal sited to left of the vertebral bodies
Treated by a Ladds procedure - division of bands and bowel returned in rotated (small bowel on right, large bowel on left, caecum in LUQ)
Malrotation and volvulus
Bilious vomiting in first few days of life
Scaphoid abdomen
Few abdominal signs
Diagnosed with USS and upper Gl contrast study
Treated with Ladd’s procedure
May be fatal if missed
Diaphragmatic hernia
Major hernias occur through Boxkdalek defects (usually left sided)
Significant herniation of abdominal contents may occur
Associated pulmonary hypoplasia may lead to poor developmental outcomes
Diagnosed on CXR at birth (of more often, antenatally)
Treated by laparotomy/ thoracotomy and repair
Tracheo-
esophageal fistula
Varying anomalies from esophageal atresias through to a variety of fistulas
“H’ type fistulas, though rare, are easily overlooked and may present later
Feeding difficulties and cyanotic spells may be seen
Early surgery is the mainstay of treatment
Congenital hernias
These include exomphalos and gastroschisis
Usually diagnosed antenatally and managed in tertiary units
Inguinal hernias
Usually occur secondary to PPV
Indirect
Easily strangulate and therefore should be repaired within a few days of diagnosis
Hirschprungs
disease
First suspected when a child fails to pass meconium in 48 hours
Abdominal distension is seen and diagnosis made by suction rectal biopsy
Treated initially by washouts and then subsequent pull through at 6 months of age
High incidence of NEC
Necrotising
enterocolitis
Patchy necrosis and subsequent perforation of the small or large bowel in neonates (often those who are unwell or premature)
Often settle with conservative management, though may develop subsequent strictures
The deteriorating infant will require laparotomy and stoma formation
What percentage of people with Meckles will develop symptoms
Approx 5%
Of these 30% will encounter bleeding
Paediatric umbilical hernia
Most umbilical hernias will resolve with non operative management and surgery under the age of 2 is not justified
Paraumbilical hernias
Seldom resolve spontaneous and require surgical repair
Omphalitis
Infection of the umbilicus
Most comman bacteria is Staph aureus
Serious condition as may rapidly spread through the umbilical vessels
Risk of portal Pyramus and portal vein thrombosis
Investigation for meckels diverticulum
Laparoscopy > nuclear scintigraphy> CT enteroclysis> CT scan > Us scan > small bowel contrast study
Technetium 99m pertechnetate nuclear scan
NEC in term babies
Rare and should always prompt search for hirschprungs disease
Persistent urachus
Usually presents with yellow liquid at umbilicus during raises intra-abdominal pressure
Associated with posterior urethral valves
Thyroglossal cyst
• Located in the anterior triangle, usually in the midline and below the hyoid (65% cases)
•Derived from remnants of the thyroglossal duct
• Thin walled and anechoic on USS (echogenicity suggests infection of cyst)
Branchial cyst
• Six branchial arches separated by branchial clefts
• Incomplete obliteration of the branchial apparatus may result in cysts, sinuses or fistulae
• 75% of branchial cysts originate from the second branchial cleft
• Usually located anterior to the sternocleidomastoid near the angle of the mandible
• Unless infected the fluid of the cyst has a similar consistency to water and is anechoic on USS
Dermoid cysts
• Derived from pleuripotent stem cells and are located in the midline
• Most commonly in a suprahyoid location
• They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat
Thyroid gland
• True thyroid lesions are rare in children and usually represent thyroglossal cysts or tumours like lymphoma
Lymphatic malformations
• Usually located posterior to the sternocleidomastoid
• Cystic hygroma result from occlusion of lymphatic
channels
• The painless, fluid filled, lesions usually present prior to the age of 2
• They are often closely linked to surrounding structures and surgical removal is difficult
• They are typically hypochoic on USS
Infantile haemangioma
• May present in either triangle of the neck
• Grow rapidly initially and then will often spontaneously regress
• Plain x-rays will shows a mass lesion, usually containing calcified phleboliths
• As involution occurs the fat content of the lesions increases
Lymphadenopathy
. Located in either tridigle of the neck
• May be reactive or neoplastic
• Generalised lymphadenopathy usually secondary to infection in children (very common)
