Operative Pediatric Surgery, 2e. Moritz M. Ziegler, MD, Richard G. Azizkhan, MD, PhD (Hon), Daniel von Allmen, MD, Thomas R. Weber, MD. Search Textbook. University of Puerto Rico, School of Medicine. University Pediatric Hospital. Chief – Pediatric Surgery. San Jorge Children Hospital. Pediatric surgery offers a unique opportunity to learn fluid and electrolyte Maintenance fluid volumes for the pediatric patient can be estimated using two.
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Download complete list of books in this Paediatric Surgery Collection .pdf) .xls) · RSS Feed Paediatric Surgery (Oxford Specialist Handbooks in Paediatrics). Professor. General & Thoracic Surgery. Topics for discussion. • What makes Pediatric Surgery unique? • Neonatal intestinal obstruction. • Abdominal wall defects. The Sages Manual of Pediatric Minimally Invasive Surgery. Danielle S. Lovell and Winter's Pediatric Orthopaedics Two-Volume Set, 7th Edition Retail PDF.
Abdominal examination should be done gently, divided in quadrants, and beginning distant from the site of complaint. It always helps if the patient is asked to help in the examination, the surgeon palpating over his hand, to reduce voluntary guarding. Image and Laboratory Image resources are poor in diagnosing appendicitis. Ultrasound, very good to assess collections, has gained popularity, as far as more experience has been achieved, and modern devices have been developed.
No lab test can confirm the diagnosis of appendicitis. The urinalysis is important to assess possible infection or calculi migration.
Massive pyuria usually preannounces urinary infection, but discrete findings can be due to appendicitis. The stump can be inverted, but nowadays simple ligation with electrocauterization is the procedure of choice. In complicated cases, with perforation and peritonitis, exhaustive cavity lavage with saline should be accomplished.
No improvement is shown by cavity antibiotic irrigation. Drainage is controversial and we do not use drains for appendicitis. Abdominal wall is approximated with Smith-Jones sutures. Primary skin closure is performed even in advanced cases. Operative time, costs, intraoperative complications such as a bleeding, stump leakage and visceral puncture are some limitations to be reduced with time and experience.
A subgroup of children obese, female, athletic benefit from the use of this surgical technique.
Antibiotic Therapy Prophylactic antibiotic is given one hour before surgery and continued for 24 hours in uncomplicated appendicitis, and must be continued for at least five to seven days, in cases of a complication perforation, peritonitis, abscess.
In the first 24 hours, close attention, and short period reexaminations, added to critical interpretation of image and lab studies will help decrease unnecessary surgery with no increase in complication rates. Cloud DT: Appendicitis. Saunders Company, Mexico City, pp , El Ghoneimi et al: Laparoscopic appendectomy in children: report of 1, cases.
J Ped Surg. Gilchrist BF et al: Is there a role for laparoscopic appendectomy in pediatric surgery? J Ped Surg 27 2 , Eur J Pediatr Surg 4: , 5.
J Ped Surg 29 8 , 6. November, Vitoria, ES, Brazil. Am J Surg March : , Surg Gyn Obst June : , Radiology , Lancet 20 : , J Ped Surg 29 10 : , Last update: September Back to Index K. Chronic Intestinal Pseudo-Obstruction Chronic Intestinal Pseudo-Obstruction is a rare disorder of intestinal motility in infants and children characterized by recurrent attacks of abdominal pain, distension, vomiting, constipation and weight loss in the absence of obvious mechanical lesions.
The disease can be familial or sporadic. Suggested etiology is degeneration of enteric nervous or smooth muscle cells. The diagnosis is based on history, physical exam, radiographies and motility studies.
Histologic pattern portrayed: myenteric plexus hyperplasia, glial cell hyperplasia, and small ganglion cells hypoganglionosis. Management is primary supportive: intestinal decompression NG , long-term TPN and antibiotic prophylaxis. Motility agents are unsuccessful. Venting gastrostomy with home parenteral nutrition has shortened the high hospitalization rate associated to this disease process.
A similar condition can be seen in early fed prematures due to immaturity of intestinal motility. Back to Index L. Bezoars Bezoars are rare foreign body concretions formed in the stomach and small bowel composed mainly of hair tricho , vegetable matter phyto or milk curds lacto. Most cases are females children, years old, with bizarre appetite trichophagia and emotional disturbances.
Originally the mass forms in the stomach and can move to the small bowel by fragmentation, extension or total translocation. The child can develop an asymptomatic palpable abdominal mass, pain, obstruction or perforation. Other children will reduce intake and develop weight loss. Predisposing conditions to bezoar formations are: gastric dymotility and decreased acidity.
Management can consist of mechanical or pulsating jet of water fragmentation via the endoscope, operative extraction, shock-wave lithotripsy ESWL with subsequent evacuation, or dissolution by oral ingestion of proteolytic enzymes papain, acetylcysteine, cellulase. With ESWL the shock wave pressure needed is less than half used for urolithiasis cases. Back to Index M.
Clinically two different types of isolated IND have been described: Type A shows symptoms of abdominal distension, enterocolitis, bloody stools, intestinal spasticity in imaging studies Ba Enema since birth, is less common and associated with hypoplasia of sympathetic nerves. Type B is more frequent, symptoms are indistinguishable from that of HD, with chronic constipation, megacolon, and repeated episodes of bowel obstruction.
Management depends on clinical situation; conservative for minor symptoms until neuronal maturation occurs around the 4th year of life, colostomy and resectional therapy for life threatening situations.
Back to Index IV. Diaphragmatic Hernias A. It is caused by failure of the pleuroperitoneal membrane to develop adequately and close before the intestines returning to the abdomen at the tenth week of gestation. The intestines then enter the pleural cavity and cause poor lung development leading to pulmonary hypoplasia a reduced number of alveoli per area of lung tissue.
This defect is postero-lateral in the diaphragm and may vary in size. Stomach, liver or spleen may be partly in chest as well. The clinical presentation is that the newborn becomes rapidly cyanotic, acidotic, and has poor ventilation. Major findings relate to the degree of pulmonary maldevelopment. Chest films will show intestines in the chest. Placement of a radiopaque nasogastric tube may show the tube coiled in the lower left chest.
Higher risk factors are: early appearance of symptoms in life, prematurity and associated anomalies. Treatment consist of rapid intubation and ventilation with use of muscle relaxants, placement of a nasogastric tube to prevent gaseous distension of the intestines and preoperative stabilization of arterial blood gases and acid-base status.
Surgery can be undertaken when one of the following objectives are met: 1 blood gases normalize with no significant changes between preductal and postductal samples, 2 echocardiogram demonstrate reduce pulmonary pressure and pulmonary peripheral resistance. Operative management consist of abdominal approach, closure of hernia by primary repair or use of mesh, and correction of malrotation. Postoperative management is very difficult. Due to hypoplastic lungs, there is frequently pulmonary hypertension leading to right-to-left shunting and progressive hypoxemia, hypercarbia, and acidosis that worsens the pulmonary hypertension.
The use of chest tubes may cause overstretching of the already hypoplastic alveoli causing: increase pulmonary hypertension, reduce functional residual capacity and reduce lung compliance. Postoperatively, the infant should be kept paralyzed and ventilated and only very slowly weaned from the ventilator.
The severity of pulmonary hypoplasia, both ipsilaterally and contralaterally, is the main determinant of outcome. ECMO extracorporeal membrane oxygenator has come to reduce somewhat the mortality of this condition. The mortality of CDH is directly related to the degree of lung hypoplasia associated. Death is caused by persistent pulmonary hypertension and right ventricular failure. Prospective studies of prenatally diagnosed fetus prior to 25 wk.
This unsolved problem has prompted investigators to develop new treatment options such as preoperative stabilization, jet-frequency ventilation, and ECMO. Another area of development is intrauterine fetal surgical repair. Intrauterine repair has meet with limited success due to herniation of the fetal liver into the chest through the defect.
Disturbance of the umbilical circulation during or after liver reduction causes fetal death. Pediatric Digestive Surgery The Surgery of Childhood Tumors, 3rd Edition. Pediatric Orthopedic Deformities Volume 1: Paediatric Orthopaedics in Clinical Practice Paediatric Orthopaedics Operative General Surgery in Neonates and Infants Practice of Paediatric Orthopaedics, 3rd Edition. Pediatric Spots. Master Techniques in Orthopaedic Surgery: Pediatrics, 2nd Edition.
Paediatric Orthopaedic Diagnosis. Key Clinical Topics in Paediatric Surgery. Contemporary Surgical Management of Fractures and Complications: Pediatrics Volume 3. Principles and Practice of Pediatric Neurosurgery, 3rd Edition. The Pediatric Spine: Principles and Practice.
Operative Pediatric Surgery. Neonatal Orthopaedics, 2nd Edition. Newborn Surgery, 3rd Edition. Pediatric Hand and Upper Limb Surgery: Paediatric Surgery offers a thorough, practical overview of the subject as well as detailed information about a wide variety of unusual and unfamiliar conditions.
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