Pediatric surgery

Pediatric surgeryClinical practice

DR. Bassam Al-Abbasi

الصور من الدكتورالشرح من كتابة الطلاب

Respiratory Distress in the Newborn

First photo:

Diagnosis: eventration of diaphragm
Description: mild dextrocardia – recurrent chest infection – diaphragm is present
mild distress - 7 months age baby – less number of intestinal loops in the chest
there is lung tissue in the chest - Paradoxical movement of the diaphragm.
Treatment: plication of the hemi-diaphragm (through thoracic approach).
Second photo:
Diagnosis: congenital diaphragmatic hernia
Description: more dextrocardia – diaphragm not present – there is nasogastric tube
severe distress – very tired - 1 day age baby – more number of intestinal loops in
the chest - there is no lung tissue in the chest.
Treatment: pull the intestine ad close the hernia (through abdominal approach).


Scaphoid abdomen

Subcostal incision

content

Defect=sac

Oesophageal Atresia and Tracheo-Oesophageal Fistula,

First photo:

Diagnosis: pure atresia
Description: radiolucent abdomen (no gases) + failure of nasogastric tube passage.
Second photo:
Diagnosis: TEF (with fistula)
Description: pass of gases to the abdomen + failure of nasogastric tube passage.

Diagnosis: TEF (atresia with fistula)

Benefits of X-ray:
1- to see the failure of nasogastric tube passage.
2- to determine the type of TEF
3- to check the condition of the lung
4- diagnose the associated anomalies (aortic arch – vertebra – ribs)
5- to measure the length of the defect (1-2-3 cm or more)


Bowel Obstruction

Diagnosis:

first photo  upper bowel obstruction // second photo  lower bowel obstruction

Description:

double bubble sign

Causes of obstruction in the first photo:

1- duodenal obstruction
2- duodenal atresia
3- annular pancreas
4- mal-rotaion of bowel

Cardinal symptoms of bowel obstruction (first photo):

1- mild abdominal distention (epigastric distention)
2- failure if pass of meconium
3- bile stain vomiting


Note:
In pediatric we cannot say small or large bowel obstruction but we say upper
or lower bowel obstruction

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N.E.C

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Meconium ileus+atresia

Description:

• Thick sticky meconium in the ileum.
• Signs of abdominal obstruction
• Abdominal duffy (مثل العجبي) mass
• No A/F level in x-ray
• Causes: cystic fibrosis
• Treatment: surgery by excision and re-anastomosis
• Before sugary  do gasrtographine enema  it could treat the condition

Description:

• Small bowel atresia
• X-ray show multiple A/F level
• Treated by surgery  resection with end to end anastomosis


Hirschprungs disease

Description:

• Two years old child
• Fist photo: Ba-enema test  show dilatation of the sigmoid and narrowing of
recto-sigmoid junction and filled with material.
• The cause is problem in the ganglia
Presentation:
• Neonate  delay to pass meconium – intestinal obstruction
• Old child  chronic constipation – complications like enterocolitis (diarrhea)
and perforation

Treatment:

Surgery called pull-through

Abdominal Wall Defects

Diagnosis: omphalocele

Description:
• Huge dilatation
• Central umbilicus
• Liver present

Treatment:

It is no emergency condition
• Cover
• Incubation
• Give fluid
• Use silo bag

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First photo:

Diagnosis: gastroschisis


Description:
• No sac
• Right to the umbilicus
• Associated anomalies are less

Treatment:

It is emergency condition
• Reduction
• Close the defect
Second photo:
Diagnosis: meningomeylocele

Note:

It is associated with hydrocephalus
and paralysis of lower limbs

Anorectal Anomalies

First and second photos:

Lateral invertogram
pubococcygeal line
It is low type
Third photo:
Lateral decubitus x-ray

Low type

Anal dimple

Pass of meconium through the urethra

High type

Subcutaneous meconium – cutaneous fistula – low type

Cloaca

High type

Vestibular type

Disorders of Sexual Development

First photo:

Diagnosis: proximal hypospadias

Description:

• Severe type
• Psychological problems
• Infection (UTI)
• Sterility
• Retrograde ejaculation

Treatment:

• By surgery
• At first year
Second photo:
Diagnosis: distal hypospadias

Intussusception

First photo:

Presentation:
• Pull leg to abdomen
• Severe screaming
• Red current jelly stool

Second photo:

• Ba-enema exam  spring cord sign
• Could do hydrostatic reduction during Ba enema test
• Other method is pneumatic reduction by air

Third photo:

• Sausage mass

In this video we see that the surgeon pull not push the intestine

Diagnosis: hemangioma

Typical history: the condition start as small red point then within few months
it become larger and after one or two years it may resolve spontaneously

Complications:

• Bleeding
• Ulceration
• Pressure may affect vision or hearing
• Bleeding tendency in huge hemangioma


Treatment:
• Spontaneous resolve
• Surgery

Note:

• First photo is cutaneous hemangiona (there is compressibility)

ANY QUESTIONS