Essentials of Pediatric Surgery

The survival of the neonates is dependent on the physiological characteristics that enable them to adapt themselves initially to the placenta and then to the extra uterine environment. Of all the pediatric patients, neonates exhibit the most distinguishing physiological features that ensure their rapid development. This chapter focuses on the physiological characteristics exhibited by the neonates in the intrauterine as well as the extra uterine environment.

Based on the investigation or attribution of the cause in children, lesions of the head and neck can be divided into different categories. Infection, Trauma, neoplasm, or congenital origin are some of the cause of lesions. The hemangioma, Lymphangiomas and cystic hygroma in children, are the widespread benign neoplasm. In children, the malignant neoplasms may include neuroblastoma, lymphoma, and rhabdomyosarcoma. The abnormal growth of cells like primary or metastatic masses in the head and neck, thyroid and parathyroid lesions, or the traumatic injuries of the head and neck represents malignant neoplasm. This chapter discusses the common congenital head and neck malformations as well as inflammatory lesions.

This chapter will include the most common cases of thoracic surgery in the pediatric age group, it ranges from congenital such as diaphragmatic hernia, lung emphysema to acquired conditions such as corrosive injury.Usually two types of deformities considered as Congenital are found to be associated with the chest wall. One may cause depression or protuberance due to overgrowth of the cartilages and the other one causing aplasia or dysplasia. Pectus carinatum (PC), is a protuberance of chest all which makes up to 10% of the chest wall abnormalities while combined PE/ PC makes up 5%, while Pectus excavatum (PE) cause a depression in the chest, thus may be called as sunken, or funnel chest. Jeune syndrome is another syndrome that may exhibit mixed features of PE/PC but is rarely found.

In this chapter we discuss common and unusual conditions of the abdomen that are treated surgically, related to the stomach, small intestine and colon. Such as Hypertrophic pyloric stenosis, is one of the most common surgical conditions of the newborn. Congenital intestinal obstruction occurs in approximately 1 in 2000 live births and is a common cause of admission to a neonatal surgical unit. Normal rotation of the intestine requires transformation from a simple, straight alimentary tube into the mature fixed and folded configuration normally present at birth. Through precise embryologic events, the duodenojejunal junction become fixed in the left upper abdomen while the cecum is anchored in the right lower quadrant. The midgut, defined as the portion of the intestine supplied by the superior mesenteric artery (SMA), is thus suspended from a wide mesenteric base.

This chapter will discuss common genital tract diseases in pediatric age group. These include undescended testis, testicular neoplasm, ovarian cyst, and ovarian neoplasm, and ambiguous genitalia. Undescended testis incidence is 30% in pre-term and 3% in full-term infants and it is associated with an increased risk of infertility and malignancy. Testicular neoplasm has different types; the most common type is yolk sac tumor. Ovarian cysts are quite common in childhood and adolescence age groups. Lastly, we will discuss ambiguous genitalia, which should address as a medical emergency condition during evaluation.

Cancer is the second leading cause of death in children after trauma and accounts for approximately 11% of all pediatric deaths in the United States. In the western countries, leukemia, central nervous system (CNS) tumors, lymphomas, neuroblastomas and nephroblastomas account for most pediatric malignancies. Neuroblastoma and nephroblastoma are among the more common solid abdominal tumors. The prognoses for these cancers have improved after numerous multicentre trials. The following description will be restricted to the most commonly encountered tumors in children.

This chapter will provide a broad overview of the more common pediatric neurosurgical conditions seen in a children’s hospital setting, with the exception of trauma. Emphasis will be placed on conditions in which the pediatric surgeon and neurosurgeon interface in the care of the child. Also, tips on what to do when a neurosurgeon is not available will be discussed. Extra effort will be spent explaining the various devices pediatric neurosurgeons implant that can very well complicate anticipated or unanticipated general surgical procedures.

At the end of week 4 of human embryonic development, paired thickenings appear in the ectoderm on the ventral aspect of the torso. Extending from the axilla to the inguinal region, they form the mammary ridges or “milk lines.” Subsequently they regress and leave a pair of primary mammary buds at the level of the fourth and fifth inter- costal spaces. The primary buds thicken into lens-shaped mammary placodes. Epithelial cells invade the underlying mesenchyme during weeks 7 and 8 to form the primitive mammary disk. In week 9, a surge of mesenchymal proliferation occurs, coincident with a thinning of the overlying epithelium. A dense mesenchymal stroma then coalesces around the bud. Between weeks 10 and 12, epithelial buds form, begin to branch, and extend into the epithelial–mesenchyme bound- ary. By the first half of the second trimester (weeks 13–20), there are 15–20 solid epithelial cords that converge at the nipples. Ramification processes continue to week 32, when the cords undergo apoptosis to establish tubules and alveoli. At birth, male and female mammary glands are equally formed. There are 20 lactiferous ducts draining into the dimple. In later stages of the final trimester, the mesoderm underlying the dimple changes it into a true nipple with an areola. Placental estrogens during the final weeks of gestation cause breast buds to enlarge to create a true breast nodule at birth, about 1 cm in size, in both genders.