Common pediatric surgical conditions

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Common pediatric surgical conditions

• Dr Nimer Disi

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Umbilical hernia Incidence 10-15
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Epigastric H

• Incidence 5 Multiple

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• Urachal remnant

• Incidence less then one in 1000
• Granuloma
• Fistulae
• Sinus
• Cyst

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Inguinal hernia

• Incidence 4
• In premature infants 16-25
• In Male 3-10 times more

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Diagnostic principles
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Treatment
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• Operation for inguinal hernia in girls
• In 20 the fallopian tube .
• (Sliding hernia ).

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• Exploration of the contra lateral Groin ??

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• - Non reducible hernia
• ( incarceration and strangulation)

• 0-3 month-------30
• 3-6 month ----------15-25
• Premature ------------ 13-18

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Diagnosis

• Irritability
• Pain tense mass
• Ischemic changes evidence of int.obst

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D.D.

• - Torsion of the testicle
• - Lymphadenitis

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• Management -----------primary reduction
• Sedation
• Analgesia
• 80 will reduce (incar.)
• Emergency operation
• Reduction (-)
• Strangulation ()

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Pre op

• NG
• IV fluid
• A.B
• S/E

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Post op complications

• Elective 2
• Incarceration 20
• Hydorcele
• Iatrogenic UDT
• Recurrent H (Direct Indirect - femoral )
• Testicular atrophy
• Injury to the Vas. Deferens

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Special considerations

• Premature infants
• UDT
• V-P shunt and peritoneal dialysis
• 14 developed Inguinal H.
• 20 - became incar.
• 16 - recurred
• Cystic fibrosis
• Inguinal H
• Absence of the vas. Def is common
• Inter sex
• Cong. Hydrocele
• Dir inguinal hernia
• Femoral hernia

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UDT

• Descent of the testes
• Trans abdominal phase
• Inguinoscrotal phase

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• Incidence

• 5 at birth
• 45 in premature
• 2 at 3 m of age

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Classification

• In the line of normal descent
• Ectopic
• Absent

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Site of U.D.T

• Superficial inguinal pouch
• Canlicular testis
• Intra abdominal testis
• Ectopic
• Vanishing testis
• Ascending testis
• Retractile testis

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• Diagnosis treatment
• Diagnosis by clinical examination

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Surgical treatment

• Fertility
• Malignant transformation
• Hernia
• Risk of torsion, trauma
• Psychological and cosmetic benefit
• Examination for testicular tm.

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Timing of orchidopexy
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Complications
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Surgical management of impalpable testis
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Exploration
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Outcome

• Testicular size
• Fertility after orchidopexy
• Testicualr cancer after orchidopexy

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The acute scrotum

• Testicular torsion
• Torsion of testicular appendages
• Epididymitis
• Orchitis
• Hernia / hydrocele
• Trauma
• Tm
• Varicocele
• Idiopathic scrotal edema