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HISTORY AND EXAMINATION An opportunistic rather than a systematic approach may be needed in the preschool child. Children should be told what to expect from examinations, investigations or procedures in terms they can understand. Fear, anxiety and pain are red...

Hydroceles A hydrocele is a fluid collection between the parietal and visceral layers of the tunica vaginalis and is usually confined to the scrotum /uni00A0 – /uni00A0 one can feel the cord above it. Occasionally , it extends into the external ring and one can...

INFANTILE HYPERTROPHIC PYLORIC STENOSIS Pyloric stenosis presents with non-bilious projectile vomiting starting between 2 and 6 weeks of age. Its presentation di ff ers from infective causes of vomiting (e.g. meningitis, urinary tract infections [UTIs]) becau...

INGUINOSCROTAL DISORDERS Undi ff erentiated gonads, influenced by the Y chromosome, develop into testes in the posterior abdominal urogenital ridges. An abdominal phase in testicular descent involves migration towards the internal ring guided by the gubernaculum...

INTUSSUSCEPTION Most intussusceptions occur between 2 months and 2 years. More than 80% are ileocolic ( Figure 17.10 ), beginning proximal to the ileocaecal valve with an apex in the ascending or transverse colon. Strangulation can progress to gangrene and per...

Idiopathic scrotal oedema Typically , a 5- to 7-year-old boy presents with a swollen hemi-scrotum with erythema extending towards the anus and the groin. The testicle is scrotal and not tender, though the dartos and skin are swollen. Antihistamines may help. I...

Impalpable undescended testes Impalpable UDTs are absent, canalicular or abdominal. Imaging is unreliable. Examination under anaesthesia and laparoscopy is performed at around 1 year. If palpable under anaesthesia, an inguinal orchidopexy is performed. At lap...

Inguinal hernia repair The herniated contents may reduce after the induction of anaesthesia. If incarcerated, the neck of the sac is found at the external ring. Open repair involves ligating the sac at the external or the internal inguinal ring. In a repair ...

and theatres. An infant’s head accounts for 20% of the surface area compared with 10% in adults. Intravenous infusions are warmed, and respiratory gases are both warmed and humidified. Core temperature is monitored in operations, and warming devices are used (...

MIDLINE HERNIAS The embryonic umbilical ring encircles a defect in the ventral abdominal wall transmitting structures connecting the fetus to the placenta ( Figure 17.8 ). Umbilical hernias are common following incomplete closure of the umbilical ring, though...

Meckel’s diverticulum A 4-year-old presenting with a haemoglobin level of 40 /uni00A0 g/L - will most likely have bled from an ulcer adjacent to a Meckel’s diverticulum containing ectopic gastric mucosa ( Figure 17.12 ) . A technetium scan may demonstrate ect...

Non-specific abdominal pain The clinical features of NSAP are similar to acute appendicitis, but the pain is poorly localised, not aggravated by movement and not accompanied by guarding. The site and severity of maximum tenderness vary on repeated examinations...

OPERATIVE SURGERY Preoperative fasting should be limited ( Summary box 17.2 ). Surgery requires meticulous and gentle tissue handling, strict haemostasis, fine sutures and magnification. Tissues should minimised. The intestine can be anastomosed with single-laye...

PAEDIATRIC SURGICAL ONCOLOGY Neuroblastoma and nephroblastoma are two solid abdominal tumours. Neuroblastomas arise in the adrenal medulla or sym - - pathetic ganglia and present with an abdominal or paraverte - bral mass. They metastasise to lymph nodes, bone...

PERIOPERATIVE FLUIDS There are four reasons for giving intravenous fluids: acute circu latory support, correction of previous losses, replacing ongoing losses and maintenance fluids ( Summary box 17.1 ). Before prescribing fluids, weight, vital signs and fluid re...

Palpable undescended testes Palpable UDTs require an orchidopexy at between 6 and 12 months. The canal is opened through an external oblique incision. The testis is mobilised on its vas and vessels, and the gubernaculum is usually divided. Any peritoneal outpo...

Rare causes of abdominal pain Other causes of acute abdominal pain include Henoch– Schönlein purpura, sickle cell disease, primary peritonitis, acute pancreatitis, biliary colic, testicular torsion, gynaecological pathology (e.g. ovarian cysts and tumours, pel...

Rectal prolapse Rectal mucosal prolapse occurs in toddlers and is exacerbated by straining or squatting on defecation. It is typically inter Eduard Heinrich Henoch , 1820–1910, Professor of Diseases of Children, Berlin, Germany , described this form of purp...