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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