Pediatric Surgery

 

 

Biliary Atresia

  • Dx: Suspected with jaundice > 2wk old. Differential includes inborn error of metabolism, CF, alpha-1-antitripsin.
    • US
    • HIDA
    • Biopsy
    • Surgery with cholangiogram
  • Tx: Kasaii

Choledochal Cyst

  • Dx: Type is determined by CT.
    • Type I= fusiform
    • Type II= diverticulum
    • Type III= choledochalcele
    • Type IV= intra/extra hepatic
    • Type V= intrahepatic
  • Tx: Management is based on type.
    • Type I - resection of biliary tree and hepaticojejunostomy
    • Type II - resect diverticulum and close
    • Type III - resect and reanastamose with duodenum or sphincterotomy with ERCP
    • Type IV - resect
    • Type V - lobectomy if unilateral

Hydrocele

  • Dx: Patients have fluid in scrotum, it transiluminates.
  • Tx: Repair If:
    • not resolved by 2 yrs old.
    • unsightly or painful.
    • infected.
    • enlarging.

Cryptorchidism

  • Dx: The testicle is not descended in the scrotum, but must differentiate from retractile testes (hold in place for 1 min, retractile testes will remain in place because cremasterics are fatigued).
    • karyotype for bilateral cryptorchidism.
  • Tx: Main reason for treatment is to allow for continued screeing for testicular cancer which has an increased incidence.
    • Repair before 1yr old. After 2yr, there is no fertility.