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.
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.
Neuroblastoma is a tumor that may arise at any site in the sympathetic nervous system, including the brain, neck (3%), chest next to the spine (20%), abdomen on either side of the aorta (24%), pelvis (3%), and adrenal gland (50%) (Figure 1). It is the second most common solid tumor of infancy and childhood, being exceeded only by brain tumors. More than 25% of cases are diagnosed before 1 year of age; 50% of cases by age 2 years, and 90% by age 8 years.
An omphalocele is a covered defect of the umbilicus (belly button) with a “sac” which contains abdominal contents. The skin and the muscle of the abdomen are missing. This problem is thought to start in the third week of development when the intestines elongate and normally reside in the yolk sac outside of the abdomen. Omphaloceles are covered by a sac composed of an outer layer and an inner layer. The umbilical cord s right into the sac. A separate compartment containing a jelly-like material also may be observed. If the omphalocele is above the umbilicus there may be other defects involving the diaphragm, sternum, and heart. If the omphalocele is below the umbilicus there may be other defects affecting the bladder, rectum, and lower spinal cord.
Pancreas divisum results when the back of the pancreas drained by one pancreatic tube and the front of the pancreas drained by another tube fail to join before joining with the main bile tube. The chances of someone having pancreas divisum are believed to be 5% to 10%, but drainage is normal in most of these people without any site of blockage.
Pancreas transplantation has been used rarely in children, but it is likely to be used more often in the future. This is because more recent improvements in immunosuppressive drugs and surgical technique have provided better results with fewer risks, and pancreatic cell (islet cell) transplantation is now being done. Pancreas transplantation is performed either as a single-organ transplant or at the same time as a kidney transplant in patients with severe kidney disease.
Malignant tumors of the pancreas are rare in infants and children. In most patients, by the time the diagnosis is made, a mass can be felt, and yellowing of the skin and eyes is often present. Patients with malignant pancreatic tumors range in age from 3 months to 16 years with most patients younger than 10 years old.
Papillary neoplastic cysts, which are rare in childhood, should be assumed to cause cancer. Only by looking at the cyst under the microscope after surgery can doctors tell if the cyst is cancerous. They are easily ruptured, and the fluid inside the cyst is extremely irritating to the inside of the belly.
The pancreas is very important to a child’s normal growth and development. It sits in the back of the abdomen, behind the stomach and does two things: 1) It produces enzymes, which help with digesting food and 2) it produces hormones such as insulin and glucagon, which help control blood sugar. In the fetus and newborn baby, the pancreas produces almost no pancreatic enzymes (amylase and lipase); then, the child’s pancreas starts making these enzymes, which help in the digestion of food. Production of these enzymes is at full adult levels by age 2 years.
There are four parathyroid glands along the behind the thyroid glands and near the edges of the gland. They are pea-sized and control calcium levels in the body. The most common disease of the parathyroid glands in children is hyperpararthyroidism.
Patent Ductus Arteriosus
Protrusion deformities of the anterior chest wall are 10 times less frequent than depression deformities. Associated disorders, including congenital heart disease, Marfan’s syndrome, spine abnormalities, and musculoskeletal defects are as frequent as in patients with pectus excavatum. The deformity typically is mild or absent in early childhood and becomes increasingly prominent during the rapid growth in early adolescence.