Pediatric Surgery
Core Concepts
Understand common pediatric surgical emergencies: appendicitis, intussusception, pyloric stenosis, malrotation, and inguinal hernia. Know the differences in presentation and management compared to adults. Key topics: neonatal bowel obstruction (duodenal atresia, jejunoileal atresia, Hirschsprung disease), abdominal wall defects (gastroschisis, omphalocele), and pediatric tumors (neuroblastoma, Wilms tumor).
Traps in Questions
A common trap is the management of intussusception: first-line is air or contrast enema reduction if no peritonitis or perforation. Another trap is pyloric stenosis: palpate olive, ultrasound shows thickened pyloric muscle; correct electrolytes before surgery. For malrotation, bilious vomiting in a neonate is a surgical emergency – do not delay for imaging if unstable. Also, beware of the “undescended testis” timing: orchidopexy by 1 year of age.
Worked Example
A 6-week-old boy with projectile vomiting, hypochloremic metabolic alkalosis. What is the immediate management? Answer: IV fluid resuscitation with normal saline and potassium, then pyloromyotomy after correction.
Rule of Thumb
In a neonate with bilious vomiting, assume malrotation with volvulus until proven otherwise – immediate surgery.