identifying and treating abdominal lump in children
TRANSCRIPT
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Abdominal Lump in childrenAbdominal Lump in children
Dr. Vivek M. RegePediatric Surgeon & Pediatric Urologist
Bhatia Hospital
Saifee Hospital
Fortis Hospitals
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Abdominal Mass in a ChildAbdominal Mass in a ChildAcute PresentationAcute Presentation
• Detailed historyDetailed history• Proper examinationProper examination• Relevant Relevant
investigationsinvestigations• Specific TherapySpecific Therapy
Chronic PresentationChronic Presentation• Discovered accidentallyDiscovered accidentally• Long standing historyLong standing history• Proper examinationProper examination• Relevant inv.Relevant inv.• Specific TherapySpecific Therapy
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Lump in abdomenLump in abdomen• Ignore the lump – may be temporaryIgnore the lump – may be temporary
• Try homeopathy, naturopathy etc…Try homeopathy, naturopathy etc…
• Try home made medicine for gas etc..Try home made medicine for gas etc..
• Why worry if there is no pain or any Why worry if there is no pain or any symptom?symptom?
• Finally go to family doctor or pediatrician Finally go to family doctor or pediatrician as it is increasing or new symptoms are as it is increasing or new symptoms are coming upcoming up
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LumpLump
• What is being treated?What is being treated?
• What is the origin of this lump?What is the origin of this lump?
• What can this lump be?What can this lump be?
• Can a child have cancer???Can a child have cancer???
• How do I find out the answers?How do I find out the answers?
• Who is the best person to consult??Who is the best person to consult??
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Children with LumpsChildren with Lumps
• All are children I have operated uponAll are children I have operated upon• Many have come after 3 months of detectionMany have come after 3 months of detection• These are only These are only somesome of the children I have of the children I have
treatedtreated• Some have come years after detectionSome have come years after detection• Cancers can and do occur in childrenCancers can and do occur in children• Cancers can be treated if detected and treated Cancers can be treated if detected and treated
in time in time
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UltrasonographyUltrasonography• Solid or Cystic massSolid or Cystic mass
• Organ of origin – Kidney, Intestines, Liver, Organ of origin – Kidney, Intestines, Liver, bladderbladder
• Dimensions of the mass – how big/small etcDimensions of the mass – how big/small etc
• Local extension in adjoining structures Local extension in adjoining structures
• Infiltration in major abdominal vessels – Aorta, Infiltration in major abdominal vessels – Aorta, IVCIVC
• Further investigations - specificFurther investigations - specific
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Large lump on left side abdomen
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Imaging
Solid mass from the kidneySolid mass from the kidney
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CT Scan Abdomen
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WILMS TUMOUR –RAJ. SURGERY
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WILMS TUMOUR - CT SCANWILMS TUMOUR - CT SCAN
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Therapy for CancerTherapy for Cancer
• Early diagnosisEarly diagnosis
• Multi disciplinary approachMulti disciplinary approach
• Surgery if possible to remove tumourSurgery if possible to remove tumour
• Chemotherapy : anti cancer drugsChemotherapy : anti cancer drugs
• Radiation therapy in some tumorsRadiation therapy in some tumors
• Regular follow up to look for recurrenceRegular follow up to look for recurrence
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Lump seen & felt in right flank 4 month oldLump seen & felt in right flank 4 month old
USG Cystic massUSG Cystic mass
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HYDRONEPHROSIS
Hydronephrosis due to obstruction at the
pelvi - ureteric junction leading to
dilated pelvicalyceal system, thinning of
the parenchyma and hold up of urine
leading to recurrent urinary infection and back pressure effects
Pelvis
Parenchyma
Ureter
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HYDRONEPHROSIS – P.U.J. OBSTR.HYDRONEPHROSIS – P.U.J. OBSTR.
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Principal of surgery
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Huge abdominal lump in 6 year old Cystic(USG), arising from left kidney
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CT Scan - Hydronephrosis
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Pelvi Ureteric Junction Obstruction with Hydronephrosis
Pelvis
Kid
ney ti
ssue
Ureter
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Large size of Functionless Kidney on Left side
KKiiddnneeyy
PelvisPelvis
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NEUROBLASTOMA
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NeuroblastomaNeuroblastoma
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RhabdomyosarcomaRhabdomyosarcoma
TumorTumor
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3 months old child with visible peristalsis going left to right – epigastric region and a palpable lump in
the abdomen
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Hypertrophic pylorus
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Transverse incison taken & abdomen opened, Transverse incison taken & abdomen opened, stomach – pyloric tumour delivered outstomach – pyloric tumour delivered out
PylorusPylorus
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PyloromyotomyPyloromyotomy
Cut through all Cut through all layers of serosa layers of serosa and muscles but and muscles but keep mucosa intactkeep mucosa intact
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Mucosa
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Barely visible scar 3 months later
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Pain in abdomen with vomiting, lump- RIF Pain in abdomen with vomiting, lump- RIF Flexion deformity of the right hip seen Flexion deformity of the right hip seen
Possibilities: Appendicular / Psoas abscessPossibilities: Appendicular / Psoas abscess
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USG – Free thick fluid and peritoneal mass.Pus in the peritoneal cavity; omentum
in RIF
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Dirty, inflammed, infected adherent Appendix with twist
Tip
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Appendix
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ABDOMINAL LUMP
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Large dumbell mesenteric cyst in proximal jejunum
Jejunum
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Resected Specimen of Cyst and Jejunum
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CT Scan – Pelvic lump - boy
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Large pelvic colon cyst in mesentery
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Abdominal LymphomaAbdominal Lymphoma
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Abdominal Lymphoma Abdominal Lymphoma
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CT Scan Abdomen - LymphomaCT Scan Abdomen - Lymphoma
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www.drvivekrege.com 9821052680/9869268680IntussusceptionIntussusception
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INTUSSUSCEPTION
Proximal
Distal
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Appendicular lumen
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BARIUM ENEMA REDUCTION
Proximal bowel
Distal colon
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BARIUM ENEMA REDUCTION
Partial reduction
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BARIUM ENEMA REDUCTION
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Free flow of Barium into
small bowel – confirms a complete
reduction of the Intussusception
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INTUSSUSCEPTIONINTUSSUSCEPTION
Ileum
Caecum
Intussusception
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Intussusception -reduced Intussusception -reduced
Gangrenous bowel
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www.drvivekrege.com 9821052680/9869268680Intussusception seen clearlyIntussusception seen clearly
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Ileo Cecal valve seen after reductionIleo Cecal valve seen after reduction
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www.drvivekrege.com 9821052680/9869268680Mass in the abdomen Left lower quadrantMass in the abdomen Left lower quadrant
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Intussuscepted mass delivered into incisionIntussuscepted mass delivered into incision
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The edge of the intussusceptum seenThe edge of the intussusceptum seen
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Intussusception being manually reducedIntussusception being manually reduced
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Intussusception prolapsing Intussusception prolapsing out of the rectumout of the rectum
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www.drvivekrege.com 9821052680/9869268680Round worm mass in the intestineRound worm mass in the intestine
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www.drvivekrege.com 9821052680/9869268680Resected loop with round wormsResected loop with round worms
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ANTENATAL ABDOMINAL MASS
Mass
Stomach
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Tumour
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Hemangioendoth.Hemangioendoth.
Right liver Right liver lobelobe
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INFANT POST OPERATIVELY
SPECIMEN CUT OPEN
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Choledochal CystCholedochal Cyst MRCP - Gall bladderMRCP - Gall bladder
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Large Choledochal cyst with gall bladder seen
Cyst
G B Liver
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Cyst opened and the communication with CBD seen proximally
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Hepato -jejunostomy anastomosis
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CystCyst
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Prenatal Diagnosis – Abdominal CystAbdominal Cyst
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Ovarian TumourOvarian Tumour
Solid mass in the OvarySolid mass in the Ovary
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Cystic mass newborn Cystic mass newborn
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Imperforate hymen with accumulation of Imperforate hymen with accumulation of blood in the uterus & vaginal cavitiesblood in the uterus & vaginal cavities
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Imperforate Hymen – older girl Imperforate Hymen – older girl
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Take Home MessageTake Home Message• Do not ignore a lump in a childDo not ignore a lump in a child
• Do not take therapy without knowing what Do not take therapy without knowing what you are dealing with - ask…..you are dealing with - ask…..
• Consult a specialist to find out moreConsult a specialist to find out more
• Do not try to self diagnose by Google…Do not try to self diagnose by Google…
• Earlier the diagnosis faster the correction Earlier the diagnosis faster the correction can occurcan occur
• Take a second opinion if any doubtTake a second opinion if any doubt
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