common paediatric surgical diseases
TRANSCRIPT
Common Pediatric Surgical
Diseases
Dr. Ali M AhmadMBBCh, MS, MD, MRCS-Ed, EBPS
Associate Pediatric Surgery; KAAUH_ PNU
Newly deliver FT Baby with excessive salivation
Case Nu 01
THINK VACTERL!
• What is your diagnosis?• What maneuver could be used to establish the Diagnosis?
•Echocardiography•Renal US
• If a distal fistula is present {why there is urgency?}
• If isolated atresia {what is the your plan?}
What are the different
surgical approach ?
Case Nu 02
Full term, 3-week old boy Non bilious projectile vomiting Hungry to feed after vomiting Few wet nappies lost weight
Visible peristaltic
Case Nu 02
What Is Your Differential Diagnosis?
A. Medical causes: GERD, GE, increased intracranial pressure, and metabolic disorders.
B. Surgical causes: HPS, Antral web, Foregut duplication cyst, Gastric tumors, or a Tumor causing extrinsic gastric compression
Case Nu 02
>15mm
> 3 mm
Abd US
What investigation could be used to establish the Diagnosis?
What is the metabolic disturbances ? hypochloraemic, hyponatraemic, hypokalaemic
metabolic alkalosis
What your approach for management? Correction of electrolyte abnormality followed by
Ramstedt Pyloromyotomy
Neonatal intestinal obstruction
1.Abdominal distension2.bile-stained vomiting3.Not pass Meconium
Volvulus neonatorumDuodenal obstruction
Small bowel atresiaNeonatal necrotizing EnterocolitisMeconium ileus
Hirschsprung's disease Duplications of the alimentary tract
Bile-stained vomiting in a normal baby
Is Surgical
until prove otherwise
Midgut Malrotation / Volvulus
Must be excluded
Case Nu 03
Newborn @ bile-stained vomiting
{Polyhydramnios}
Down syndrome in about 30% of cases
Duodeno - duodenostomy
What is your diagnosis
Good intestine + Bad Baby
Bad intestine+ Good Baby
Omphalocele. Gastroschisis
What is thissilo
A newborn baby develops
Abdominal distensionbile-stained vomitingNot pass Meconium
Small bowel atresia
What is your diagnosis
18
What you know about other management ?
What is your diagnosis
What is your diagnosis
What is common site of anal fissure – what you think?
What is your diagnosis
Extensive NEC
Small left colon syndrome.
What is your diagnosis
2 weeks-old female
diabetic mother
Meckle's diverticulum
What is this study
26
Simple wedge resection of the Meckel’s diverticulum.
If bleeding has been a problem it is important to resect the adjacent distal ileum to ensure that the bleeding point/ulcer is included in the resection.
What other presentation ?
What is this study
What is your diagnosis
What is the name of this procedure
Unilateral Frog-Leg Maneuver
Remember to remove diaper
Remember to remove diaper
MCQs
A- Metabolic acidosis with compensatory respiratory alkalosis.
B- Is commoner in females than males.
C- Produces bilious vomiting in premature babies.
D- Can usually be diagnosed on clinical examination alone.
E- Can be demonstrated by ultrasound abdomen.
Congenital hypertrophic pyloric stenosis
D& E
A - A preliminary gastrostomy can be fashioned prior to thoracotomy and reconstitution of esophageal continuity.
B- A concomitant duodenal atresia can be seen as a double bubble on abdominal X-ray.
C - Maternal polyhydramnios may prompt early neonatal investigation.
D - Gastrografin swallow is required for confirmatory diagnosis.
E - Concomitant cardiac anomalies should be considered.
Esophageal Atresia Without TEF
A, C &E
A - commonest reason for emergency abdominal surgery.
B - Requires serological investigation in all cases prior to operation.
C- Should be managed with pre-operative analgesia.
D- Requires only one dose of pre-op antibiotic for prophylaxis against wound infection.
E- Is often distinguished from non-surgical causes of abdominal pain by repeated clinical examination alone.
Childhood appendicitis
All except B
Common Pediatric Surgical
Diseases
Dr. Ali M AhmadMBBCh, MS, MD, MRCS-Ed, EBPS
Associate Pediatric Surgery; KAAUH_ PNU
THANK YOU