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Pediatric surgeryClinical practice
DR. Bassam Al-Abbasi
الدكتور من الصور
الطالب كتابة من الشرح
Head and Neck
Cleft lip and palateProblems: • 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 hygromaNotes: • 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 tumor2- Neuroblastoma3- Neglected PUJ obstruction
Presentation: 1- Mass2- hematuria3- hypertension
Treatment by surgery remove the kidney + chemotherapy
Neuroblastoma in the adrenal gland
Diagnosis: non-Hodgkin lymphoma
Presentation: 1- Mass2- Intussusception
Investigation: FNA
Treatment: surgery + chemotherapy (for one year)
Diagnosis: Sacro-coccygeal teratoma
Problems: 1-obstructed labor2- Malignancy (if neglected for 2-3 months)
Treatment: surgery + remove the coccyx to prevent recurrence
Spleen, Pancreas and Biliary Tractمطلوب غير
مطلوب غير
First photo: Diagnosis: rectal prolapseCauses: • Constipation or diarrhea• Weak pelvic muscles • Worm (trichuris trichiura)Grades: • Grade1 ويرجع conservative treatment by taping يطلع• Grade2 للدخول دفع الى ويحتاج surgery (Therach operation) يطلع• Grade3 ابد يرجع وما surgery (Therach operation) يطلع
Second photo: Diagnosis: Perianal fistula Treatment: surgery (fistulectomy or fistulotomy)
Third photo: Diagnosis: rectal polypCause 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
مطلوب غير
مطلوب غير
ANY QUESTIONS