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Common pediatric surgical conditions By Dr Hatem ElGohary

  1. 1. Dr. Hatem ELGohary Lecturer of General Surgery Helwan University
  2. 2. Thermoregulation less subcutaneous fat – wide surface area – immature peripheral vasomotor mechanisms. Action: Warm IV fluids – Warm theater – Insulate child
  3. 3. Gastro-oesophegeal Reflux and Aspiration Action: Naso-gastric tube Infection Immature immune system Action: Antiseptic conditions – proper Antibiotics. Clotting disorders Action: Preoperative intramuscular vit. K
  4. 4.  Gentle.  In Warm Theater.  Under Antiseptic condition.  Bipolar Diathermy.  Absorbable fine sutures.
  5. 5. Causes
  6. 6. Arrested along its normal pathway of descent.
  7. 7. typically present in the scrotum in early infancy; it can be manipulated into the bottom of the scrotum without tension but tends to be pulled up by the cremaster muscle. With time, the testis resides permanently in the scrotum; however, follow-up is advisable as, rarely, the testis subsequently ascends into the inguinal canal.
  8. 8. lies outside its normal line of descent, most often in the perineum or femoral triangle. An undescended testis may be palpable in the groin or at the neck of the scrotum or it may be impalpable if absent or located in the abdomen or inguinal canal.
  9. 9. Investigations
  10. 10.  Ultrasound inguinal and femoral region  Laparoscopy  Hormonal in bilateral impalpable testis to detect testosterone rise after IM HCG
  11. 11. Risk
  12. 12. Fertility. To optimise spermatogenesis the testis needs to be in the scrotum below body temperature at a young age. Malignancy. Undescended testes are histologically abnormal and at an increased risk of malignancy. Cosmetic and psychological. In an older boy a prosthetic testis can be inserted to replace an absent one.
  13. 13. Treatment
  14. 14. Orchidopexy is usually undertaken as a day-case procedure. The testis is mobilised through an inguinal incision, preserving the vas deferens and testicular vessels. The associated patent processus vaginalis is ligated and divided and the testis is placed in a subdartos scrotal pouch. Orchidectomy is often unilateral intra-abdominal testis, which cannot be corrected by orchidopexy because of the future risk of malignancy. In cases of bilateral intra-abdominal testes, microvascular transfer and staged orchidopexy are two options available to preserve the testes if the testicular vessels are too short to permit a single- stage orchidopexy.
  15. 15. Acquired disorder, hypertrophy of the circular muscle layer increases the length and diameter of the pylorus. More in Boys between 2 to 8 weeks.
  16. 16. Symptoms: Non billious vomiting at the end of the feed. Signs: .Visible gastric peristalsis from left to right. .Olive-tumour felt in the epigastrium to the right hypochondrium. U/S: shows the thickened pyloric muscle.
  17. 17. 1. Rehydration 2. Correction of electrolytes imbalance 3. Ramstedt’s pyloromyotomy

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