Foreign Bodies and Bezoars
Ingestion of foreign bodies is a problem because of the tendency for small children to put everything into their mouths. There may or may not be history of ingestion of a foreign body. If a foreign body does not become stuck in the duodenum or at the first part of the small intestine (ligament of Treitz), it ordinarily passes through the intestinal tract. A foreign body that perforates the intestine may produce obstruction.
Gastroesophageal Reflux and Other Disorders of Esophageal Function
Fundoplication is currently either the first or the second most commonly performed intra-abdominal procedure in infants and children in most pediatric surgical centers. Since the 1970s, surgical correction for gastroesophageal reflux (GER) has been performed by wrapping the upper stomach around the esophagus either a partial (Thal, Boix-Ochoa, Dor, Toupet) or complete (Nissen) fundoplication. In general, it seems that the Nissen fundoplication is more effective in preventing GER, but it may lead to difficulty swallowing and troublesome bloating in some patients compared with a partial fundoplication, which seems not as effective in preventing reflux. These symptoms after the Nissen procedure seem to be minimized with use of an appropriate-sized esophageal tube used as a “sizer” and division of the blood vessels that attach the stomach to the spleen for sufficient mobilization of the stomach.
Prior to the 1960s, the outcome of infants born with holes in their abdominal wall (abdominal wall defects) was poor. The development of modern breathing machines for infants, nutrition that could be delivered directly into the blood, and man made synthetics that could act as a covering for the abdomen greatly improved the survival of these patients. Recently, the ability to diagnose these defects during pregnancy, further advances in the neonatal intensive care unit (NICU) management of infants, and the development of the modern operating room techniques and technology have led to most patients surviving.
Hirschsprung's Disease - Part 1 of 3
Descriptions of children with Hirschsprung's Disease date back to the 17th century, when Ruysch (1691), a Dutch anatomist, described a 5-year-old girl who died of intestinal obstruction. The first clinical description of Hirschsprung's Disease was presented at the Berlin Society of Pediatrics in 1886 by Hirschsprung. He thought that the disease was caused by distention of the colon, as evidenced by the title of his presentation: "Constipation in Newborns Due to Dilation and Hypertrophy of the Colon." As a result of Hirschsprung's presentation, however, attention was focused on the consequences of the abnormality rather than the actual cause of the disease.
Hirschsprung's Disease - Part 2 of 3
Hirschsprung’s disease often presents in newborns as intestinal blockage or obstruction occurring most commonly in the colon or rectum. The child may or may not have an infection called enterocolitis, resulting from the obstruction. This is caused by to many bacteria (overgrowth) in the affected segment of intestine. Although the incidence of enterocolitis is variable, this complication makes the diagnosis and early treatment of Hirschsprung’s disease urgent. In the mildest case, delayed passage of meconium (the stool first passed by a baby) may be the only abnormality.
Hirschsprung's Disease - Part 3 of 3
Hydrops (Swelling) of the Gallbladder
Acute swelling of the gallbladder in the absence of gallstones is a well-recognized problem. Hydrops may occur as a newborn and in older children. This condition is characterized by the development of a fluid collection around the gallbladder and main bile duct that drains the liver.
Congenital hyperinsulinism, also called nesidioblastosis, is a problem in babies in which insulin control is abnormal, causing low blood sugar. Patients with this syndrome may have signs of low blood sugar without actually having a high insulin level, showing that they have a problem with insulin control.
Grave’s disease (hyperthyroidism) is generally diagnosed in adults, but can be seen in children. This can cause enlargement of the thyroid gland (goiter). Although this usually occurs in older children, it can be seen in infants of mother’s with Grave’s disease. Infants generally respond to medicines (iodine and propylthiouracil) and do not require surgery.
A series of developmental steps are involved in the formation of the normal anatomy of the lower end of the anus, rectum, and genitourinary (GU) tract. By the fourth week of development, the cloaca and a structure called the cloacal membrane are present. The cloaca is a normal structure in birds and is present for a short period of time during the development of the human before birth. A cloaca is a structure into which the colon, urinary tract and genitalia all drain and exit the body with a single opening. A human goes thorough a stage of development where a cloaca normally exists and then goes on to develop separate openings for the rectum, urinary tract and in girls, the vagina. This normal development is in much part due to the development of a structure called the cloacal membrane. If the membrane does not develop normally the cloaca may persist at birth in girls or boys will develop some variant of imperforate anus.
Inguinal Hernia and Hydrocele
Inguinal hernia is a common condition of infancy and childhood, and repair is the most frequently performed general surgical operation in childhood.
There are many forms and causes of intussusception, but the most common in children is where the last portion of the intestine (the ileum) goes into the first portion of the colon (cecum). This intussusception is an important cause of belly pain and intestinal blockage in infants and requires immediate medical attention. Intussusception occurs in the United States in 2 to 4 per 1000 live births and more commonly (60%) in boys. Intussusception of infancy is seen most commonly between 6 and 10 months of age, with 65% of the children being less than 1 year of age. There seems to be a seasonal incidence, with two peaks occurring (1) in spring and summer and (2) in the middle of winter, corresponding to times of the year with an increased incidence of viral gastroenteritis (GI virus), colds, and flu. While there is no obvious cause, it generally is believed that GI virus leads to swelling of lymph glands in the intestine which leads to one piece of intestine "telescoping" into another.
The need to have one’s gallbladder removed is generally due to the formation of gallstones. Gallstones form when there is an imbalance in the components in the bile that is normally stored in the gallbladder. For most people, there is no known reason why gallstones develop. Nevertheless, there are diseases that can predispose your child to form gallstones. Children who have problems with blood cells being broken down easily such as can happen in spherocytosis and sickle cell anemia have increased incidence of gallstone formation.
Malrotation is an abnormal arrangement or twisting of the intestine inside the abdomen, which is also known as volvulus, that may result in loss of blood flow to the intestine. This abnormal arrangement or twisting of the intestine can also cause blockages of the intestines by causing a kinking of the intestine without loss of blood flow. A delay in recognizing these conditions can result in damage to the intestine as well as danger to the life of the child.
Meckel's diverticulum is an out pouching from the intestine caused by an abnormality during the development of the fetus and it occurs between 5 and 7 weeks after conception.
Meconium ileus is the intestinal blockage which is due to cystic fibrosis. Approximately 15% to 20% of infants with CF present with intestinal obstruction related to meconium ileus. Although it originally was thought that CF primarily affected the pancreas, it now is known that it also affects the secretions from the intestine.
Meconium Plug/Small Left Colon Syndrome
Meconium plug and neonatal small left colon syndromes share sufficient similarities to be discussed together. Patients have transient colonic obstruction most likely due to poor function. The principles of diagnosis and management are similar.
Cysts (fluid filled lumps), solid lumps, and sinuses (small openings) found about the head and neck are frequently residual structures from embryologic development that have failed to resorb completely or mature. Some lumps may be caused by inflammation, infection or even tumors affecting lymph nodes in the neck area.
Necrotizing Enterocolitis (NEC)
Necrotizing enterocolitis (NEC) is the most serious and frequent stomach and intestinal (gastrointestinal, GI) problem of low-birth-weight infants. The result of dramatic improvements in the management of the lung and nutritional needs of premature infants has improved the immediate survival of the infants so now they are living longer and, thus, have a greater chance of developing NEC.