12.08.30 Paediatric surgery

Hydrocele

    • Distinguishing from hernias

      • Can pinch off and feel cord structures above

      • Transilluminate more than hernias

    • Types

      • With patent processus vaginalis

        • Increasing volumes of fluid can get trapped

        • Potential for hernia formation too

      • Without PPV

        • Usually resolve without intervention within 18 months

    • Consequences

      • None really

        • cf Varicocele (raised temp causes infertility)

      • Watchful waiting generally fine

    • Frequency

      • 30 % at birth

Inguinal hernias

    • Distinguishing

      • Can't get above it

      • Easier to reduce

    • Frequency

      • 4% at birth

    • Risk of incarceration

      • 50% at 6 months

      • 7% at 1 year

Pyloric stenosis

    • Develops over the first month of life

    • Tends to present at 5-6 weeks

    • Treat by making an incision in the mucosa, allowing the muscular tissue of the sphincter to expand outwards

Undescended testes

    • Frequency

      • 3% at birth

    • Outcome

      • 65% fix themselves within 6 months

      • Wait 6 months, then operate

    • Risks

      • 90% also have PPV

        • => May present with hernia

      • 1% risk of testicular cancer if not fixed by puberty

    • NB testes can re-ascend during rapid pubertal growth

Testicular torsion

    • Occurrence

      • Neonates

      • Adolescents

    • Presentation

      • Excruciating pain over whole testicle

      • Ascending pain

        • Inguinal / iliac fossa

        • Careful to distinguish from appendicitis!

Umbilical hernia

    • 30% of neonates

    • Almost never obstruct

    • => Watchful waiting

Idiopathic scrotal oedema

    • Usually bilateral

      • cf torsion, (epididymo)-orchitis

    • Raw red skin over and around testicle

    • But testes are not tender underneath

    • Resolves in 2-3 days without intervention

Balanitis

    • Inflammation of the glans of the penis

    • Distinguish from just the tip

      • Washing

      • Irritation

    • cf Balanitis xerotica obliterans

Duodenal atresia

    • "Double-bubble" sign on X-ray

      • Stomach + proximal duodenum

    • Bile-stained vomit

    • Extremely serious

      • Transfer immediately to tertiary pediatric surgery centre

Lower intestinal obstruction

    • Hirschsprung's disease

      • Caused by the failure of the neural crest cells to migrate completely

      • Intestine doesn't relax => Blockage

    • Meconium ileus

      • In cystic fibrosis

Vitello-intestinal Duct Remnants

    • Vitello-intestinal duct or omphalo-mesenteric duct connects the midgut to the yolk sac during early embryonic life

    • It gets obliterated and disappears during fifth to sixth week of intrauterine life.If the remnants persists then following abnormalities can occur:

      • Umbilical Polyp

      • Umbilical Sinus

      • Fibrous remnant of vitello-intestinal duct

      • Meckel's Diverticulum

      • Patent Vitello-intestinal duct