PAEDIATRIC SURGICAL CONDITIONS
PAEDIATRIC SURGICAL CONDITIONS
Duodenal atresia:
- Often associated with Down syndrome
- Presents postnatally with bile-stained vomit
- Abdominal X-ray: double bubble sign (air in stomach and first part of duodenum)
- Treatment: surgical correction
Anorectal atresia/imperforate anus:
- Incidence: 1 in 4,000 births
- Presents with failure to pass meconium
- May have stenosed/mispositioned anus
- Often associated with fistula to urethra/vagina
- Treatment: surgical formation of colostomy for higher lesions
- Post-op: anal dilation with graded dilators for several months
- Complications: faecal incontinence (managed with diet, enemas, medications)
Umbilical hernia:
- Painless, reducible swelling at the umbilicus
- More prominent with crying
- More common in black ethnicity, premature/low birth weight
- Associated with trisomy 21, 18, 13
- Usually spontaneous resolution
- Surgical referral if persists >4 years
- Rare strangulation
Inguinal hernia:
- More common in premature/low birth weight/male
- Acute: irreducible, growing mass requiring emergency admission
- Non-acute: intermittent groin/scrotal swelling
- Treatment: herniotomy
- Highest strangulation risk in the first year, especially premature
Diaphragmatic hernia:
- Incidence: 1 in 2,500 live births
- Bowel herniation into the chest cavity
- Detected antenatally or presents with respiratory distress
- Diagnosis confirmed on chest X-ray
Exomphalos:
- Failed return of the gut to the abdominal cavity during development
- Umbilical swelling with a membrane-covered gut
- Antenatal detection at 14-week scan
- Treatment: surgical repair at a specialist unit
- Good prognosis post-repair
Gastroschisis:
- Abdominal wall defect with exposed gut prolapse
- Antenatal detection at 14-week scan
- Treatment: surgical repair at a specialist unit
- Good prognosis post-repair