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Learning objectives After studying this chapter, you will be able to: Outline subspecialisations within children’s surgery • Safely prescribe perioperative /f_l uids in children • Compare and contrast inguinal hernias and hydroceles • Discuss the causes and ma...

Anorectal malformations In an anorectal malformation, there is usually no opening in boys, and the rectum ends either blindly (notably in aneuploi dies) or with a fistula to the bulbar urethra ( Figure 18.13a prostate or bladder neck. Occasionally , there is a ...

Biliary atresia/choledochal malformation Congenital or acquired (e.g. cytomegalovirus) extrahepatic biliary atresia is a progressive obliterative cholangiopathy with absent or narrow bile ducts. Type I involves the common bile duct, type II the common hepatic ...

Congenital mesoblastic nephroma This renal tumour may present as a large palpable mass in a newborn with some having hypertension and hypercal - caemia (paraneoplastic syndromes). Cross-sectional imaging distinguishes a tumour from a multicystic dysplastic kid...

Duodenal atresia The obstruction in duodenal atresia usually lies just distal to the ampulla of Vater. The proximal duodenum and pylorus dilate with swallowed amniotic fluid, rendering the pylorus temporarily incompetent. Occasionally , there is a web that may...

Exomphalos Exomphalos describes a central abdominal wall defect in which prolapsed viscera are covered in a thin, three-layered membrane (peritoneum, Wharton’s jelly and amnion) in continuity with the umbilical cord. Exomphalos minor (<5 /uni00A0 cm, liver not...

Gastroschisis In gastroschisis, an abdominal wall defect lies to the right- hand side of the umbilical cord and transmits the small and large intestine, stomach, bladder and sometimes the ovaries or undescended abdominal testes ( Figure 18.16 ). Risk factors i...

Hirschsprung’s disease Genetic defects (e.g. RET , EDNRB, EDN3 ) can a ff ect the - migration of neural crest-derived intestinal neurones (neuro - ), cristopathy), leading to aganglionosis and thickened nerve trunks in the distal bowel. There may be a family h...

INTRODUCTION Neonatal surgeons are paediatric surgeons who manage life-threatening non-cardiac congenital anomalies and the acquired condition necrotising enterocolitis (NEC), seen in premature babies. Structural anomalies are associated with gene defects, ane...

Learning objectives To be able to: List /f_i ve aetiological classes underlying structural • congenital anomalies Give /f_i ve examples of how neonatal physiology and • anatomy in /f_l uence surgical care Describe at least /f_i ve congenital anomalies managed ...

Malrotation and volvulus Complex rotations in utero give the small bowel mesentery its broad, stable base, running from the duodenal–jejunal (DJ) flexure in the left upper quadrant to the caecum in the right lower quadrant. Incomplete rotations leave the mesent...

Meconium ileus Inspissated meconium may cause a distal ileal obstruction. A segmental ileal volvulus can follow and create an atresia. If the ileum perforates, it may seal or persist and cause a large meconium pseudocyst. An abdominal radiograph shows obstruct...

NEONATAL GASTROINTESTINAL SURGERY Oesophageal atresia/ tracheoesophageal fi stula (OA/TOF) Five anatomical variations appear in Figure 18.1 . When the oesophagus ends blindly , amniotic fl uid cannot be swallowed - and polyhydramnios results. If there is no ...