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.
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 0 evening · pyloromyotomy
First feeds started
One small vomit after second feed
Wound clean
Parents alarmed
Has the operation failed?
The read
Almost certainly not: vomiting after early feeds is common while the stomach relearns emptying, and feeding regimens tolerate it. The counselling to the parents is the treatment here. The escalations are different pictures: persistent forceful vomiting for days (incomplete myotomy is rare but real) or an unwell baby with a tender abdomen (the feared missed mucosal perforation declares itself within the first day).
Day 2 of NEC, medical management
Girth up 1.5 cm overnight
Aspirates bilious, increasing
Platelets 90 from 160
Film: pneumatosis unchanged, no free air
The film is stable, so is the baby?
The read
No: the film lags the bowel. Rising girth, climbing aspirates and consuming platelets are a trajectory argument that necrosis is progressing, and trajectory outranks a single stable image. This board earns surgical review at the cotside today and a lowered threshold for the next film and the operative conversation, not reassurance from radiology's silence.
Post-op evening · school-age appendicectomy
HR 128 (age norm ~80-110)
BP normal for age
Quiet, not interested in tablet games
Urine not yet passed since theatre
Which number matters, given the normal blood pressure?
The read
The heart rate and the quietness: children defend blood pressure to the end, so tachycardia with behavioural change is the earliest honest signal of hypovolaemia, pain or evolving sepsis. Examine, treat pain, give a measured fluid bolus if the picture fits, chase the urine, and reassess within the hour: the paediatric ward's rhythm is short-loop reassessment, because deterioration is quiet and then sudden.
Emergencies
The calls that cannot wait
Midgut volvulus
Recognise: Bilious vomiting in a neonate, with or without distension, with or without distress: the soft abdomen excludes nothing.
First move: Urgent contrast study or straight to theatre if unstable: hours decide whether this child keeps a digestive tract, and the referral is made at the first green vomit.
NEC with perforation or collapse
Recognise: A preterm infant with NEC who deteriorates: free air, a fixed loop, falling platelets, rising support.
First move: Joint neonatal-surgical decision at the cotside: drain or laparotomy, resecting only certain death, with the intensive care running through the operation rather than pausing for it.
The incarcerated infant hernia
Recognise: A firm, tender, irreducible groin swelling in an unsettled or vomiting infant: bowel and testis both at risk.
First move: Analgesia and expert taxis reduce most, converting an emergency into an urgent repair on the same admission; the irreducible or unwell child goes to theatre now.
Intussusception with compromise
Recognise: The episodic story plus peritonitis, bile, blood or a shocked, drowsy child: the telescoped bowel is no longer just congested.
First move: Resuscitate with measured boluses, image, and move along the enema-or-theatre pathway with surgery and radiology in one conversation.
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.