Pediatric Surgery By Noor Ahmed Esraa Abdulwahab Supervised

Pediatric Surgery By: Noor Ahmed Esraa Abdulwahab Supervised by: Dr. Ali Farooq

Inguinoscrotal disorders

Case 1: 4 month old male, with history of prematurity, presented with a right sided intermittent bulge in the groin, mainly during crying or straining, sometimes descending to the scrotum, and reduces spontaneously, the child looks well, the skin over the bulge looks normal.

Q & As -What is the diagnosis? Inguinal hernia. -What is the most common type in this age group? Indirect inguinal hernia. -What is the management and when? Surgical. As soon as they are diagnosed.

Suppose the child was presented tense irreducible swelling, crying, vomiting, abdominal distention and constipation, what do you think had happened now? Incarcerated hernia. Strangulated hernia. Obstructed hernia.

Taxis procedure -sedation. -elevate the lower body. -ice packs over the swelling. -reduce upward and posteriorly.

If on examination, the testis was not palpable, the bulge was cystic, and you did the test shown below: What is the name of the test? Transillumination test. -What's the most probable diagnosis? Hydrocele. -What's the difference between hernia and hydrocele? -what’s the management?

Diffirence between hernia and hydrocele: • Cystic. • Irreducible. • Transilluminate. • No impulse on crying. • Impalpable testis. • Can get above.

Cryptorchidism The second most common problem in pediatric surgery after inguinal hernia. Descent is important, why? -more common in: Premature. Right sided.

Failure of the descent will result in undescended testis. -Palpable or impalpable? - Retractile testis?

Diagnosis History and examination. Imaging studies. Laparoscopy (95% sensitivity).

Management -Surgical. . Timing? Orchiopexy. Orchioctomy. risks of UDT: Malignancy Infertility Trauma Infection

Acute scrotum

Case 2 A 9 years old male, presented to the ER with sudden onset of right sided scrotal pain, he has previous history of minor similar attackes, he has no history of trauma, associated with nausea and vomiting, no fever or urinary symptoms. on examination the right hemiscrotum is swollen, tender and red and high riding testis.

Qs & As -What is the most probable diagnosis? Testicular torsion. -What are the types of this condition? Extravaginal (neonate). Intravaginal (puberty). -how much time till correction. 6 hours.

Classification -Intravaginal (puberty). Bell clapper deformity. -Extravaginal (perineonatal). Poor attachment to the scrotum.

In neonate: Firm, dark and non tender testis might be present at birth. Testicular salvage might not be possible.

Diagnosis Examination ( loss of cremastric reflex). Doppler U/S !

Management - Manual detorsion. . What is it called? Open the book. - Surgical orchiopexy, if gangrenous, then we do orchiectomy. - Was the problem solved? nope! DO BILATERAL ORCHIOPEXY.

Home massage !

Suppose the patient presented with the same scrotal condition, but was associated with fever, malaise and rigor , and urinary symptoms.

Qs & As -What is the most probable diagnosis? Epididymo-orchitis. -what is the cause? Rare in prepubertal male, unless There is underlying anomaly (VUR, Ectopip testis. . ) -what are the ultrasound findings? Hypervasculrity. Reactive hydrocele. in addition to voiding cystourthrogram

Management Bed rest. Hydration. Analgesics. Scrotal elevation (prehn’s sign). Antibiotics with follow up US if no response. . Abscess.

Common GIT problems

Case 3: You are working in the ER, a mother brings her 5 weeks old child, complaining of projectile white colored vomiting, started 2 days go, progressively increasing, now occurring after each feeding. -What’s the most probable diagnosis? Pyloric stenosis. -is it congenital or acquired? Acquired ! - What to find on examination?

Olive mass visible peristalsis

Diagnosis -Laboratory ( what are the findings and why? ). -US ! 16/4

Erect abdominal xray Double track sign string sign

Management -Stop oral feeding. -Correction of hydration (150 ml/kg of 0. 45% NS + 20 meq of KCl in 1 liter fluid) -Surgery is not an emergenry. (pyloromyotomy).

Case 4 8 month old infant, presented with rectal bleeding, greenish vomiting, with crying and irritability, on examination, there was a palpable mass in the RUQ. -what’s the most likely diagnosis? Intussusception. -Name of this stool? Red currant jelly stool. -What is the cause of it ? Mucus and blood. -what is sign of dance?

Red currant jelly stool

Classification -primary. -secondary (leading point). Anatomical classification: Ileocolic (77%). Ileoileocolic. Ileoileal. Etc.

Diagnosis -presentation. (PR is important) -imaging studies.

Contrast studies

Management Non operative management : Pneumatic or hydrostatic reduction under fluoroscopic or US guidance. If : failed manual method, complicated and atypical age of presentation , surgery is indicated.

Thank you!