Common Paediatric Surgical Problems Philip Morreau Starship www.kidzhealth.co.nz
Dec 16, 2015
Common Paediatric Surgical Problems
Philip Morreau
Starship
www.kidzhealth.co.nz
What is Paediatric Surgery?
Small bowel atresia
Reality = rare & common problems
Condition Type of referral
Abdominal pain-Acute Needing admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate.
Vascular anomalies Diagnostic uncertainty, airway, vision, hearing Area of special concern
Epigastric hernia When noted Fax or letter
Foreskin
Asymptomatic non-retractile foreskin does not usually need assessment.
Starship does not perform Circumcision for cultural nor religious reasons
If prepuce looks scarred Fax or letter
Recurrent infection Fax or letter
Fused labia As soon as diagnosed Fax or letter
Hydrocele
If persistent after 2 years of age Fax or letter
At any age if diagnostic uncertainty Fax or letter
Hypospadias As soon as diagnosed Fax or letter
Inguinal hernia Reducible - < 6 months of age Phone /urgent fax
Reducible - > 6 months of age Fax or letter
Irreducible or if symptomatic or difficult to reduce (including female)
Phone/immediate referral & attention
Paraphimosis As soon as diagnosed Phone/immediate referral & attention
Testicular torsion Suspected – i.e. Acute scrotal pain Immediate phone call
Umbilical hernia
After 3 years of age Fax or letter
Acutely in rare event of irreducibility Phone/immediate referral & attention
Undescended testisIf both not fully descended by 3 months post term
Fax or letter
Normal penis
Phimosis
Glanular adhesions (and meatal cyst)
BXO
Hypospadias
Smegma
paraphimosis
Hernia Vs Hydrocele
Bilateral hydroceles
• Painless
• Scrotal
• Can not reduce
Bilateral Inguinoscrotal Hernia
Inguinal hernia
N.B.
• IRREDUCIBLE GROIN LUMP
• Inguinal hernia• Encysted hydrocele of
the cord• undescended testis• lymphangioma
• HYDOCELE• Scrotal• Can’t reduce• Painless• (trans illumination)
UDT Vs Retractile?
• testes in the scrotum at birth
• normal size testis
• manipulated to bottom scrotum
• does not retract immediately
• cord not tight, nor painful
• resides in scrotum some of time
? UDT
Testicular Torsion
Testicular Torsion
Hydatid of Morgagni
Testicular Torsion
Neonatal Torsion
Traps!
• Epididymo-orchitis
• HSP
• ultrasound
• RIF pain
• trauma
• tumour
Umbilical hernia
Haemangioma
Haemangioma- treat with β blocker ??
Condition Type of referral
Abdominal pain-Acute Needing admission and/or urgent assessment. Immediate referral to CED, Starship with phone call if thought appropriate.
Vascular anomalies Diagnostic uncertainty, airway, vision, hearing Area of special concern
Epigastric hernia When noted Fax or letter
Foreskin
Asymptomatic non-retractile foreskin does not usually need assessment.
Starship does not perform Circumcision for cultural nor religious reasons
If prepuce looks scarred Fax or letter
Recurrent infection Fax or letter
Fused labia As soon as diagnosed Fax or letter
Hydrocele
If persistent after 2 years of age Fax or letter
At any age if diagnostic uncertainty Fax or letter
Hypospadias As soon as diagnosed Fax or letter
Inguinal hernia Reducible - < 6 months of age Phone /urgent fax
Reducible - > 6 months of age Fax or letter
Irreducible or if symptomatic or difficult to reduce (including female)
Phone/immediate referral & attention
Paraphimosis As soon as diagnosed Phone/immediate referral & attention
Testicular torsion Suspected – i.e. Acute scrotal pain Immediate phone call
Umbilical hernia
After 3 years of age Fax or letter
Acutely in rare event of irreducibility Phone/immediate referral & attention
Undescended testisIf both not fully descended by 3 months post term
Fax or letter