Common paediatric cases

Question 1

What are inguinal hernias?

Answer 1

Abnormal protrusion of intra-abdominal contents either through the deep inguinal ring (indirect inguinal hernia; lateral to the inferior epigastric artery) or through the weakened posterior wall of the inguinal canal (direct inguinal hernia; medial to the inferior epigastric artery)

Question 2

What are the risk factors of infant inguinal hernia?

Answer 2

Due to patent processus vaginalis
Premature birth
Urogenital dysplasia syndromes
Increased intraabdominal pressure (e.g., gastroschisis, ascites, omphalocele)
Weakness of the connective tissue (e.g., Ehlers-Danlos syndrome)

Question 3

What is the treatment for infant inguinal hernia?

Answer 3

Surgery

Question 4

What is intestinal malrotation and midgut volvulus?

Answer 4

Intestinal malrotation: arrest in the normal rotation of the gut in utero, resulting in an abnormal orientation of the bowel and mesentery within the abdominal cavity
Midgut volvulus: torsion of a malrotated midgut causing mechanical bowel obstruction, mostly in neonates and infants

Question 5

What are the clinical features of malrotation?

Answer 5

Usually asymptomatic

Question 6

What are the clinical features of midgut volvulus?

Answer 6

Bilious vomiting with abdominal distension

Signs of bowel ischemia: hematochezia, hematemesis, hypotension, and tachycardia

Question 7

What is the treatment for midgut volvulus?

Answer 7

(Initial resuscitation) nil per oral; nasogastric tube insertion; IV fluids; correction of electrolyte imbalance; broad-spectrum IV antibiotics
(Then surgery) Emergency surgery (Ladd procedure)