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.
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Conditions
The diseases, each with the image that defines it.
Each disease with the image that defines it: what it looks like, what the scan shows, and which operation answers it.
Intussusception
Telescoping bowel, episodic pain, and a treatment delivered by air.
- Mechanism
- A proximal segment telescopes into a distal one, dragging its mesentery: venous congestion, then the mucosal bleeding of redcurrant stool, then ischaemia if unreduced.
- The clinical shape
- Episodic screaming with drawing-up, pallor and lethargy between episodes, a sausage-shaped mass, and late redcurrant stools: the between-episode drowsiness is a warning in its own right.
- Diagnosis and reduction
- Ultrasound's target sign confirms; air (or contrast) enema reduces most, performed with surgery aware and the child resuscitated, since reduction has a perforation rate.
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- Surgery's share
- Peritonitis, perforation, failed enema, recurrence and the older child's pathological lead points: operative reduction or resection, and a reminder that recurrence within days is common enough to warn families about.
Hypertrophic pyloric stenosis
A muscle problem presenting as a chemistry problem.
- The disease
- The pyloric muscle hypertrophies over weeks in early infancy, narrowing the outlet until feeds return forcefully: hunger persists because nothing is wrong downstream.
- The biochemistry
- Pure gastric losses drain acid and chloride: hypochloraemic hypokalaemic metabolic alkalosis, with the kidneys eventually producing the famous paradoxically acidic urine. The gas tells you how deranged, and therefore how ready.
- Diagnosis
- Ultrasound measures the muscle's thickness and length; the test feed's visible peristalsis and palpable olive are the classical examination.
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- Treatment
- Fluid and electrolyte correction first, over a day or more if needed, then pyloromyotomy, splitting the muscle down to intact mucosa: curative, elegant, and never an emergency.
Malrotation & midgut volvulus
An embryology error that becomes a stopwatch.
- The embryology
- The midgut herniates, rotates 270 degrees and returns in fetal life; incomplete rotation leaves a narrow mesenteric pedicle and misplaced caecum with Ladd's bands across the duodenum.
- The catastrophe
- A narrow pedicle lets the whole midgut twist around the superior mesenteric artery: volvulus strangles the bowel from duodenum to mid-transverse colon, the entire future digestive capacity of a child.
- Recognition
- Bilious vomiting in a neonate is the alarm phrase: the abdomen may be soft and the baby initially well, and the urgent upper GI contrast study is the answer, not observation.
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- Ladd's operation
- Detort, divide the bands, widen the mesentery, straighten the duodenum, remove the appendix: the anatomy is made safe rather than normal, and speed at the first presentation is what the outcome remembers.
Necrotising enterocolitis
The preterm gut's gravest complication.
- The setting
- Prematurity is the dominant risk: an immature mucosal barrier, immature immunity and enteral feeding's demands meet in the second and third week of life. Breast milk is protective.
- Recognition
- Feed intolerance, distension, bilious aspirates and bloody stools in a preterm infant, with the film's vocabulary (pneumatosis, portal venous gas, free air) grading the stage.
- Medical management
- Gut rest, decompression, antibiotics and intensive support, with serial films and joint neonatal-surgical review: many babies recover without an operation.
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- Surgical thresholds and stakes
- Perforation or deterioration despite maximal care brings surgery: resect only the clearly dead, preserve every possible centimetre, and accept staged returns, because short bowel is the price of generosity with the scissors.
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.