in the name of godpgnrc.sbmu.ac.ir/uploads/541_5184_1586937943025_dr... · 2020. 4. 15. ·...
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In the name of GOD
Leily MohajerzadehPediatric surgeon
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Leily Mohajerzadeh MDLeily Mohajerzadeh MDassistant Professor Of Pediatric Surgery & Pediatric Urology
Mofid Children’s Hospital Shaheed Beheshti University of Medical Sciences
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Case 1
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What is the diagnosis ?diagnosis ?What is the
optimum age of surgery?
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Examination for an inguinal hernia
A single finger is laid over and parallel to the
inguinal structures,
and the finger is rubbed across the cord from
side to side at the level of the pubic tubercle
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inguinal herniAn inguinal hernia will not resolve spontaneously, so resolve spontaneously, so surgical closure is always
indicated.
Because of the high risk of incarceration,particularly in
young infants, repair should be performed expeditiously.
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Case 2
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Case 2
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(1) The defect is it is only rarely
present at birth,
Umbilical hernia is distinguished from other
anomalies by two features:
(1) The defect is covered by normalskin
present at birth, instead usually
becoming apparent in the first weeks or
months of life
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Case 3
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Hypospadias
is one of the most common congenital anomalies,
occurring in approximately 1 in 250 newborns, or roughly 1 in 125 live male
births.
Hypospadias can be defined as an arrest in normal development of the urethra,foreskin,
and ventral aspect of the penis
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Case 4
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-neonate with excessive salivation in the first few hours of life.
-The first feeding is followed by regurgitation,choking, and
coughing.
pass a firm catheter through the mouth into the esophagus to the point at which resistance is meet.
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Type A Type B Type C: Type DType A :8%
Type B0.8%
Type C:85.5%
Type D1.4%
Type E4.2%
Type F
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and a period of Immediate surgery for
EA with distal TEF is seldom
necessary,
and a period of 24 to 48 hours
between diagnosis and
surgery permits full assessment
of the infant
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Case 5
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Neonate with respiratory symptoms (cyanosis,
gasping,sternal retractions, and poor respiratory effort )
within the first 24 hours of life
infant has a scaphoid abdomen and an asymmetric distended chest.heart sounds hear best over the right chest .
Differential Diagnosis :1-eventration of the diaphragm, 2-anterior diaphragmatic hernia of Morgagni,3-congenital esophageal hiatal hernia4- congenital cystic disease of the lung5- primary agenesis of the lung
Ventilation by mask and Ambubag is contraindicated
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Respiratory distress
uncorrectable uncorrectable pulmonary pulmonary hypoplasia
reversible reversible pulmonary
hypertension
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Case 6
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What is the diagnosis ?
What is the optimum age of surgery?
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Gastroschisis is less than 4 cm in diameter
,
It is almost always to the right of the umbilical cord, although exceptions do occur
usually contains only the midgut with the stomachand possibly a gonad
At birth the bowel can appear
matted.
At birth the bowel can appear perfectly normal, but more than 20 minutes after birth, extruded intestine may be thickened and covered with a fibrinous exudatematted.
rapid transfer from the delivery room to the operating room (<1 hour) will also lead to a greater likelihood of primary closure.
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What is the diagnosis ?
What is the optimum age of surgery?
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Omphalocele is a large defect (>4 cm) covered by
amniotic membrane
that contains midgut and other abdominal organs including the liver
and often the spleen and gonad
second after gastroschisis.
incidence is 1 to 2.5 per 5000 live births,
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PROSTHETIC SILO
HAND –SEWN SILO
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Case 8
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It is also less than 4 cm and contains only the midgut
it contains only midgut, never liver.
Few associated
with this defect.
Few associated
anomalies are reported with this defect.
Like all abdominal defects in which the midgut has not returned to the abdominal cavity before birth to allow for rotation and fixation,these patients have malrotation
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Case 9
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What is the diagnosis ? What is the optimum age of
surgery?
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Bladder exstrophy is a rare midline defect and exists as part of a larger spectrum of abdominal-pelvic fusion abnormalities, known collectively as the exstrophy-epispadias complex
• Functional Closurein infants younger
than 72 hours
• Epispadias Repair6 and 12 months
of age
• Bladder Neck Reconstruction and Ureteroneocystostomy4 years of age
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