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Pediatric surgery
Clinical practice
DR. Bassam Al-Abbasi
‫الصور من الدكتور‬
‫الشرح من كتابة الطالب‬
Head and Neck
Cleft lip and palate
Problems:
• Aspiration during feeding
• Nasal speech
• Cosmetic problems
• Affect the hearing (glue ear)
• Lead to recurrent chest infection
Surgery:
• In 6 months to 1 year for cleft palate
• In 3 months for cleft lip
Feeding:
• Use special bottle tit
• In setting position
Cleft lip repair (cheiloplasty)
First photo:
Diagnosis: thyroglossal cyst
Problems:
• Lead to infection
• Lead to fistula
• Could convert to malignancy
Need surgery  remove the fistula tract + remove the hyoid bone to
prevent recurrence
Second photo:
Diagnosis: cystic hygroma
Notes:
• It is due to lymphatic obstruction
• Common at the sites of communication between the trunk and the extremities
like cervical region, axilla, groin.
Treatment:
• By surgery: it depends on presence of complications like compression, infection
bleeding (rapid increase in size and become pale and shock)
• During surgery be careful to some nerves like hypoglossal never, spinal
accessory nerve, mandibular branch of facial nerve
Diagnosis:
sternocleidomastoid torticollis (first photo)
sternocleidomastoid mass (second photo)
Notes:
• Ask about breech presentation and obstructed labor
• If not treat the mass it could be converted to torticollis
• Treatment of mass is by physiotherapy by twisting the chin and movement of
ear and massage  90% will disappear  if not treated do surgery by
cutting the mass and muscle.
• Treatment of torticollis is by surgery.
First photo:
Diagnosis: External angular dermoid
Notes:
• Treated by surgery  excision and complete remove
• Problems  infection, trauma, cosmetic
Second photo:
Diagnosis: remnant of second branchial arch  branchial cyst or fistula
Site: anterior border of sternocleidomastoid muscle between tonsil
and lower two third of sternocleidomastoid muscle
Problems: infection – malignancy
Treatment: surgery (excision)
The Umbilicus
First photo:
Diagnosis: umbilical hernia
Treatment: could resolve spontaneously or by surgery
Second photo:
Omphalo-mesenteric duct  connection between umbilicus and bowel
Diagnosis: Michaels diverticulum
Role of 2:
• 2% of population.
• 2 type of mucosa(ectopic gastric mucosa).
• 2 feet from iliocecal valve.
• 2 inches in length.
Presentation:
• Bleeding per rectum (painless – bright red – profuse)
• Infection (lead to abdominal pain)
• Complication  intestinal obstruction, volvulus, intussusception
• Incidental finding
Diagnosis:
• Use isotope (bind to gastric tissue (parietal cell) within the Michaels)
• Laparoscope (diagnostic and therapeutic)
Vomiting in the First Months of Life
Diagnosis: pyloric stenosis
Presentation:
• Projectile vomiting (not present in first two weeks)
• Olive mass in the abdomen
• Positive prestalsis
• FTT
Diagnosis:
• Clinically
• Ultrasound
• Ba-meal  dilated stomach – failure to pass to intestine – string sign
Treatment: surgery  pyloromyotomy (rami stick surgery)
Diagnosis: achalasia cardia
Presentation:
• Hailtosis
• Vomiting (not projectile)
• Wheezing
• Chest infection
Ba-swallow  dilatation of esophagus with narrowing of lower part.
Treatment  cardiomyotomy
The Child with an Abdominal Mass
5 years child, presented with mass in the flank.
DDx of mass in the flank:
1- Wilms tumor
2- Neuroblastoma
3- Neglected PUJ obstruction
Presentation:
1- Mass
2- hematuria
3- hypertension
Treatment by surgery  remove the kidney + chemotherapy
Neuroblastoma in the adrenal gland
Diagnosis: non-Hodgkin lymphoma
Presentation:
1- Mass
2- Intussusception
Investigation: FNA
Treatment: surgery + chemotherapy (for one year)
Diagnosis: Sacro-coccygeal teratoma
Problems:
1-obstructed labor
2- Malignancy (if neglected for 2-3 months)
Treatment: surgery + remove the coccyx to prevent recurrence
‫غير مطلوب‬
Spleen, Pancreas and Biliary Tract
‫غير مطلوب‬
First photo:
Diagnosis: rectal prolapse
Causes:
• Constipation or diarrhea
• Weak pelvic muscles
• Worm (trichuris trichiura)
Grades:
• Grade1  ‫ يطلع ويرجع‬ conservative treatment by taping
• Grade2  ‫ يطلع ويحتاج الى دفع للدخول‬ surgery (Therach operation)
• Grade3  ‫ يطلع وما يرجع ابد‬ surgery (Therach operation)
Second photo:
Diagnosis: Perianal fistula
Treatment: surgery (fistulectomy or fistulotomy)
Third photo:
Diagnosis: rectal polyp
Cause in infection
Red-bleed mass + bleeding per rectum
Treatment: excision (use sigmoidoscope)
Hernia
Varicocele
Diagnosis: undescended testes
Problems:
• Tumor
• Sterility
• Infection
• Orchitis (like appendicitis)
Treatment:
• If palpable  do fixation
• If not palpable  do laparoscopy
• If not present  do nothing
‫غير مطلوب‬
‫غير مطلوب‬
ANY QUESTIONS