Chapter 8. Pediatric Surgery
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1 Chapter 8 Pediatric Surgery
2 8.1 Hydrocephalus Hydrocephalus is a congenital disorder. There may be difficulties during normal vaginal delivery due large size of the head. In 1970s, when these pictures were taken, ventriculo-caval or ventriculo-peritoneal shunts were the only options for a general surgeon to manage such cases. To maintain one-way flow of CSF, Prof. Upadhyaya had developed his valve and incorporated in the shunts in those years. (8.1a, 8.1b, 8.1c, 8.1d) 158
3 Chapter 8 Pediatric Surgery 8.1a 8.1b 8.1c 8.1d 159
4 Atlas of Surgery 8.2 Congenital Neural Lesions Congenital lesions. Encephalocele (8.2a, 8.2b). Neural tumor of facial nerve (8.2c). Chordoma; tumor of the remnant of notochord (8.2d)
5 Chapter 8 Pediatric Surgery 8.2a 8.2b 8.2c 8.2d 161
6 Atlas of Surgery 8.3 Spina Bifida Spina bifida is a developmental disorder in which lower lumbo-sacral vertebrae are not fused. A tuft of hair or a deep dimple may indicate underlying spinabifida. Radiology can confirm. (8.3a, 8.3b) This leads to bulging of meninges under the skin called meningocele (8.3c, 8.3d) 162
7 Chapter 8 Pediatric Surgery 8.3a 8.3b 8.3c 8.3d 163
8 Atlas of Surgery 8.4 Congenital Spinal Lesions Meningocele and meningo-myelocele. Meningoceles in spina bifida are closed lesions. The meninges are so thin that the swellings may be transparent to light, and in sacral spines may show the nerves of Filumterminale (8.4a, 8.4b). Sometimes even the posterior part of the spinal cord is poorly developed leading to the exposure of spinal canal on the surface of the skin called meningo-myelocele. This is serious because it can lead to ascending meningitis and encephalitis; hence must be closed as an emergency (8.4c, 8.4d)
9 Chapter 8 Pediatric Surgery 8.4a 8.4b 8.4c 8.4d 165
10 Atlas of Surgery 8.5 Vascular Malformations Vascular malformations and haemangiomas of neck, face and gluteal regions. (8.5a, 8.5b, 8.5c, 8.5d) 166
11 Chapter 8 Pediatric Surgery 8.5a 8.5b 8.5c 8.5d 167
12 Atlas of Surgery 8.6 Congenital Lesions Lymphatic malformation (previously called cystic hygroma) (8.6a, 8.6b). Gastroschisis (Exposed abdominal contents) (8.6c). Omphalocele (Peritoneal contents enclosed in a peritoneal sac, but no other coverings) (8.6d)
13 Chapter 8 Pediatric Surgery 8.6a 8.6b 8.6c 8.6d 169
14 Atlas of Surgery 8.7 Hernias in Children Umbilical hernias (8.7a, 8.7b). Abdominal contents protrude in a sac, covered by layers of the abdominal wall. Lumbar hernias (8.7c, 8.7d). Developmental weakness of muscles leads to herniation
15 Chapter 8 Pediatric Surgery 8.7a 8.7b 8.7c 8.7d 171
16 Atlas of Surgery 8.8 Congenital Lesions 8.8a. Ano-rectal malformation. 8.8b. Anal stenosis. 8.8c. Vaginal Botyroid tumor (Rhabdomyosarcoma)
17 Chapter 8 Pediatric Surgery 8.8a 8.8b 8.8c 173
18 Atlas of Surgery 8.9 Congenital Deformities Congenital deformities of hands and feet. (8.9a, 8.9b)
19 Chapter 8 Pediatric Surgery 8.9a 8.9b 175
20 Atlas of Surgery 8.10 Ascariasis Ascariasis [8.10 a-d]. Worm infestations of GIT in children are very common in tropical countries. In my practice in India, I encountered many manifestations caused by roundworms. [Ascaris Lumbricoides]. A patient came with a history of passing roundworms through rectum, vomiting worms, and even worms coming out of nose. Mostly they were children. Intestinal obstructions caused by these worms are quite common; I used to operate on at least one case every month. In most cases, history was suggestive. In cases with abdominal distension, simple plain x-ray and contrast study of GIT were helpful. Explorations revealed bowel loops loaded with worms, leading to obstruction, even necrosis requiring resections. The number of worms used to be in a thousand! 176
21 Chapter 8 Pediatric Surgery 8.10 a 8.10b 8.10 c 8.10 d 177
22 Atlas of Surgery 8.10 (e) shows a ball of entangled worms in right iliac fossa (e) and 8.10 (f) show worms in the small intestine in plain x-ray (g) shows a nasogastric tube blocked by a worm
23 Chapter 8 Pediatric Surgery 8.10e 8.10f 8.10g 179
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