common pediatric surgical conditions 3 dr hatem el gohary
TRANSCRIPT
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Common Pediatric Surgical ConditionsDr. Hatem El GoharyLecturer of General Surgery MD, MRCS
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Hirschsprung Disease
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Definition
Developmental disorder of the enteric nervous system and is characterized by an absence of ganglion cells in the distal colon resulting in a
functional obstruction[.
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Aetiology
Innervation of the colon: • Extrinsic: Mainly lead to Increase in smooth muscle tone.• Interinsic: Relaxation of the colon.
• Congenital aganglionosis of the distal bowel
• Both the myenteric (Auerbach) plexus and the submucosal (Meissner) plexus are absent, resulting in reduced bowel peristalsis and function.
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Diagnosis
Symptoms:• Newborn with delayed passage of meconium.• Chronic constipation• Vomiting, Distention, poor feeding, and failure to thrive.
Signs:• Distended abdomen. • Spasm of the anus.
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Investigations
1 -Barium enema Narrowed distal colonProximal dilationTransition zone
2 -Full Thickness rectal biopsy Aganglionosis
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TREATMENT
• Rehydration and Nasogastric tube.• Diverting colostomy at the time of diagnosis. Then• Swenson procedure : Resection of the aganglionic
segment and oblique anastomosis of the colon.
• Duhamel procedure Resection of the aganglionic segment and end to side anastomosis of the colon.
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IMPERFORATE ANUS
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Embryology
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• The rectum and anus are believed to develop from the dorsal potion of cloacal cavity,
• Downgrowth of the urorectal septum is believed to close this duct by 7 weeks' gestation.
• This septum separates the rectum and anal canal dorsally from the bladder and urethra.
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Aetiology
Defects in the formation or shape of the posterior urorectal septum.
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Types
• A low lesion, in which the colon remains close to the skin.
• A high lesion, in which the colon is higher up in the pelvis.
• A persistent cloaca , in which the rectum, vagina and urinary tract are joined into a single channel.
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Diagnosis
• Identified upon the first physical examination.• Failure to pass meconium within 24 hours.
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• X-Ray Lateral view Upside down.
< 1cm …low> 1cm …high
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Common Association
VACTERLVertebral anomaliesAnorectal (e.g.imperforate anus)Cardiac
Tracheal (e.g.fistula)EosophegealRenalLimb
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Treatment
< 1 cm Primary neonatal pull-through.
> 1 cm Colostomy Then Pull - through.
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