Pediatric surgery Clinical practice DR. Bassam Al-Abbasi

الصور من الدكتور الشرح من كتابة الطلاب

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 recurrance 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 lengthe. 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 mechaels) 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

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

ANY QUESTIONS