in the name of godpgnrc.sbmu.ac.ir/uploads/541_5184_1586937943025_dr... · 2020. 4. 15. ·...

In the name of GOD

Leily MohajerzadehPediatric surgeon

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Leily Mohajerzadeh MDLeily Mohajerzadeh MDassistant Professor Of Pediatric Surgery & Pediatric Urology

Mofid Children’s Hospital Shaheed Beheshti University of Medical Sciences




Case 1




What is the diagnosis ?diagnosis ?What is the

optimum age of surgery?




Examination for an inguinal hernia

A single finger is laid over and parallel to the

inguinal structures,

and the finger is rubbed across the cord from

side to side at the level of the pubic tubercle




inguinal herniAn inguinal hernia will not resolve spontaneously, so resolve spontaneously, so surgical closure is always

indicated.

Because of the high risk of incarceration,particularly in

young infants, repair should be performed expeditiously.




Case 2




(1) The defect is it is only rarely

present at birth,

Umbilical hernia is distinguished from other

anomalies by two features:

(1) The defect is covered by normalskin

present at birth, instead usually

becoming apparent in the first weeks or

months of life




Case 3




Hypospadias

is one of the most common congenital anomalies,

occurring in approximately 1 in 250 newborns, or roughly 1 in 125 live male

births.

Hypospadias can be defined as an arrest in normal development of the urethra,foreskin,

and ventral aspect of the penis




Case 4




-neonate with excessive salivation in the first few hours of life.

-The first feeding is followed by regurgitation,choking, and

coughing.

pass a firm catheter through the mouth into the esophagus to the point at which resistance is meet.

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Type A Type B Type C: Type DType A :8%

Type B0.8%

Type C:85.5%

Type D1.4%

Type E4.2%

Type F




and a period of Immediate surgery for

EA with distal TEF is seldom

necessary,

and a period of 24 to 48 hours

between diagnosis and

surgery permits full assessment

of the infant




Case 5




Neonate with respiratory symptoms (cyanosis,

gasping,sternal retractions, and poor respiratory effort )

within the first 24 hours of life

infant has a scaphoid abdomen and an asymmetric distended chest.heart sounds hear best over the right chest .

Differential Diagnosis :1-eventration of the diaphragm, 2-anterior diaphragmatic hernia of Morgagni,3-congenital esophageal hiatal hernia4- congenital cystic disease of the lung5- primary agenesis of the lung

Ventilation by mask and Ambubag is contraindicated

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Respiratory distress

uncorrectable uncorrectable pulmonary pulmonary hypoplasia

reversible reversible pulmonary

hypertension




Case 6




What is the diagnosis ?

What is the optimum age of surgery?




Gastroschisis is less than 4 cm in diameter

,

It is almost always to the right of the umbilical cord, although exceptions do occur

usually contains only the midgut with the stomachand possibly a gonad

At birth the bowel can appear

matted.

At birth the bowel can appear perfectly normal, but more than 20 minutes after birth, extruded intestine may be thickened and covered with a fibrinous exudatematted.

rapid transfer from the delivery room to the operating room (<1 hour) will also lead to a greater likelihood of primary closure.




What is the diagnosis ?

What is the optimum age of surgery?




Omphalocele is a large defect (>4 cm) covered by

amniotic membrane

that contains midgut and other abdominal organs including the liver

and often the spleen and gonad

second after gastroschisis.

incidence is 1 to 2.5 per 5000 live births,




PROSTHETIC SILO

HAND –SEWN SILO




Case 8




It is also less than 4 cm and contains only the midgut

it contains only midgut, never liver.

Few associated

with this defect.

Few associated

anomalies are reported with this defect.

Like all abdominal defects in which the midgut has not returned to the abdominal cavity before birth to allow for rotation and fixation,these patients have malrotation




Case 9




What is the diagnosis ? What is the optimum age of

surgery?




Bladder exstrophy is a rare midline defect and exists as part of a larger spectrum of abdominal-pelvic fusion abnormalities, known collectively as the exstrophy-epispadias complex

• Functional Closurein infants younger

than 72 hours

• Epispadias Repair6 and 12 months

of age

• Bladder Neck Reconstruction and Ureteroneocystostomy4 years of age




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