Pediatric Surgery By: Noor Ahmed - PowerPoint Presentation

Slide1

Pediatric Surgery

By: Noor Ahmed

Esraa

Abdulwahab

Supervised by: Dr. Ali Farooq

Slide2

Inguinoscrotal disorders

Slide3

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.

Slide4

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.

Slide5

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.

Slide6

Taxis procedure

-sedation.

-elevate the lower body.

-ice packs over the swelling.

-reduce upward and posteriorly.

Slide7

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?

Slide8

Diffirence between hernia and hydrocele:

Cystic.

Irreducible.

Transilluminate

.

No impulse on crying.

Impalpable testis.Can get above.

Slide9

Cryptorchidism

The second most common problem in pediatric surgery after inguinal hernia.

Descent is important,

why?

-more common in:

Premature.

Right sided.

Slide10

Failure of the descent will result in undescended testis.

-Palpable or impalpable?

- Retractile testis?

Slide11

Diagnosis

History and examination.

Imaging studies.

Laparoscopy (95% sensitivity).

Slide12

Management

-Surgical .. Timing?

Orchiopexy

.

Orchioctomy

.

risks of UDT:MalignancyInfertility

Trauma

Infection

Slide13

Acute scrotum

Slide14

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.

Slide15

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.

Slide16

Classification

-

Intravaginal

(puberty).

Bell clapper deformity.

-

Extravaginal

(

perineonatal

).

Poor attachment to the scrotum.

Slide17

In neonate:

Firm, dark and non tender

t

estis might be present at birth.

Testicular salvage might not be possible.

Slide18

Diagnosis

Examination ( loss of

cremastric

reflex).

Doppler U/S !

Slide19

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.

Slide20

Home massage !

Slide21

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

,and urinary symptoms.

Slide22

Qs & As

-What is the most probable diagnosis?

Epididymo-orchitis

.

-what is the cause?

Rare in

prepubertal male, unlessThere is underlying anomaly (VUR,

Ectopip

testis..)

-what are the ultrasound findings?Hypervasculrity.Reactive hydrocele

.

in

addition to voiding

cystourthrogram

Slide23

Management

Bed rest.

Hydration.

Analgesics.

Scrotal elevation (

prehn’s

sign).Antibiotics with follow up US if no response.. Abscess.

Slide24

Common GIT problems

Slide25

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?

Slide26

Olive mass visible peristalsis

Slide27

Diagnosis

-Laboratory ( what are the findings and why?).

-US !

16/4

Slide28

Erect abdominal

xray

Double track sign

string sign

Slide29

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

).

Slide30

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?

Slide31

Red currant jelly stool

Slide32

Classification

-primary.

-secondary (leading point).

Anatomical classification:

Ileocolic

(77%).

Ileoileocolic.Ileoileal

.

Etc.

Slide33

Diagnosis

-presentation. (PR is important)

-imaging studies.

Slide34

Contrast studies

Slide35

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.

Slide36

Thank you!