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