Common Paediatric Surgical Problems

Philip Morreau

Starship

www.kidzhealth.co.nz

What is Paediatric Surgery?

Small bowel atresia

Reality = rare & common problems

Condition Type of referral

Abdominal pain-Acute Needing admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate.

Vascular anomalies Diagnostic uncertainty, airway, vision, hearing Area of special concern

Epigastric hernia When noted Fax or letter

Foreskin

Asymptomatic non-retractile foreskin does not usually need assessment.

Starship does not perform Circumcision for cultural nor religious reasons

If prepuce looks scarred Fax or letter

Recurrent infection Fax or letter

Fused labia As soon as diagnosed Fax or letter

Hydrocele

If persistent after 2 years of age Fax or letter

At any age if diagnostic uncertainty Fax or letter

Hypospadias As soon as diagnosed Fax or letter

Inguinal hernia Reducible - < 6 months of age Phone /urgent fax

Reducible - > 6 months of age Fax or letter

Irreducible or if symptomatic or difficult to reduce (including female)

Phone/immediate referral & attention

Paraphimosis As soon as diagnosed Phone/immediate referral & attention

Testicular torsion Suspected – i.e. Acute scrotal pain Immediate phone call

Umbilical hernia

After 3 years of age Fax or letter

Acutely in rare event of irreducibility Phone/immediate referral & attention

Undescended testisIf both not fully descended by 3 months post term

Fax or letter

Normal penis

Phimosis

Glanular adhesions (and meatal cyst)

BXO

Hypospadias

Smegma

paraphimosis

Hernia Vs Hydrocele

Bilateral hydroceles

• Painless

• Scrotal

• Can not reduce

Bilateral Inguinoscrotal Hernia

Inguinal hernia

N.B.

• IRREDUCIBLE GROIN LUMP

• Inguinal hernia• Encysted hydrocele of

the cord• undescended testis• lymphangioma

• HYDOCELE• Scrotal• Can’t reduce• Painless• (trans illumination)

UDT Vs Retractile?

• testes in the scrotum at birth

• normal size testis

• manipulated to bottom scrotum

• does not retract immediately

• cord not tight, nor painful

• resides in scrotum some of time

? UDT

Testicular Torsion

Testicular Torsion

Hydatid of Morgagni

Testicular Torsion

Neonatal Torsion

Traps!

• Epididymo-orchitis

• HSP

• ultrasound

• RIF pain

• trauma

• tumour

Umbilical hernia

Haemangioma

Haemangioma- treat with β blocker ??

Condition Type of referral

Abdominal pain-Acute Needing admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate.

Vascular anomalies Diagnostic uncertainty, airway, vision, hearing Area of special concern

Epigastric hernia When noted Fax or letter

Foreskin

Asymptomatic non-retractile foreskin does not usually need assessment.

Starship does not perform Circumcision for cultural nor religious reasons

If prepuce looks scarred Fax or letter

Recurrent infection Fax or letter

Fused labia As soon as diagnosed Fax or letter

Hydrocele

If persistent after 2 years of age Fax or letter

At any age if diagnostic uncertainty Fax or letter

Hypospadias As soon as diagnosed Fax or letter

Inguinal hernia Reducible - < 6 months of age Phone /urgent fax

Reducible - > 6 months of age Fax or letter

Irreducible or if symptomatic or difficult to reduce (including female)

Phone/immediate referral & attention

Paraphimosis As soon as diagnosed Phone/immediate referral & attention

Testicular torsion Suspected – i.e. Acute scrotal pain Immediate phone call

Umbilical hernia

After 3 years of age Fax or letter

Acutely in rare event of irreducibility Phone/immediate referral & attention

Undescended testisIf both not fully descended by 3 months post term

Fax or letter