SurgSpace / Specialties / Pediatric Surgery
Pediatric Surgery
Surgery of children and neonates, where the diseases are congenital as often as acquired, the anatomy still moving, and the doses, tubes and consent all scale with age. Bilious vomiting in a baby is this specialty's 'chest pain': an emergency until proven otherwise.
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
A nine-month-old with ultrasound-confirmed ileocolic intussusception: 14 hours of symptoms, soft abdomen, perfused and resuscitated. Air enema or operation?
Air enema reduction
The standard of care for the stable child: high success rates, no incision, with surgery informed and theatre available because reduction can perforate.
Straight to theatre
For peritonitis, free air, the shocked child, or a failed enema: operative reduction, and resection where the bowel has already declared itself.
The enema is a treatment with entry criteria, not a soft option: a resuscitated child, no peritonitis, no free air, and a surgical team in the loop. The sequencing lesson generalises: radiology and surgery are one pathway here, not rival plans.
Pyloric stenosis confirmed at 19:00: chloride 82, bicarbonate 34, a dry-looking baby. The registrar asks about booking theatre tonight.
Resuscitate tonight, operate when corrected
The correct tempo: fluids and electrolyte correction over 24 to 48 hours, operating on a chloride and bicarbonate that have normalised.
Operate tonight
The classic error: an alkalotic baby hypoventilates and can arrest post-operatively, and nothing about the pylorus will worsen overnight on a drip.
Pyloric stenosis is a medical emergency and a surgical non-emergency: the danger is the chemistry, not the muscle. 'Never operate on an alkalotic baby' is the specialty's most quoted tempo rule, and understanding why (respiratory compensation meets anaesthesia) makes it stick.
A 900-gram infant with NEC: pneumatosis yesterday, today a fixed loop, falling platelets and rising pressor requirement, no free air on the film.
Continue maximal medical care
Defensible while the trajectory holds: gut rest, antibiotics, support and serial review. The absence of free air does not mean the absence of dead bowel.
Operate on deterioration
The fixed loop, falling platelets and climbing support are necrosis speaking without a perforation's punctuation: laparotomy (or a drain first, in the smallest) on clinical grounds.
Free air is a late and unreliable messenger in NEC: the deteriorating baby with a fixed loop and consumptive picture has earned surgical review at the cotside, and the decision is made on trajectory. The operating principle once there: resect only what is certainly dead, and count centimetres like currency.
The rotation
Your first day here
- Bilious vomiting in a baby is a surgical emergency until proven otherwise: if you learn one phrase this rotation, learn that one.
- Look at the observation chart's age-based ranges before judging any number: a toddler's normal is an adult's alarm and vice versa.
- Weights are clinical data: every drug, fluid and decision runs per kilogram, so find the weight before you find the drug chart.
- A quiet child is more worrying than a crying one: energy for protest is a good sign, and its loss is a trajectory.
- Watch a children's nurse do a full set of observations and an examination-by-stealth: the craft of assessing children without a fight is learnable and worth learning.
- In theatre, notice the scale of everything, tubes, sutures, blood volumes, and the anaesthetic room choreography with parents: the specialty's culture is half its method.
Hub shaped by the Surgical Specialties Lead with the Paediatric surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.