Pediatric Surgery Handbook

43 Pages·2001·0.211 MB·English

by  Lugo-Vicente H.

KOOBDNA HYREGRU SCIRTAIDEP
*P A,AS F C,,ADeFMtneciV -oo tgLrueLbmuH
yreg rcuiSrtai drfeooPtce reitDaicoss A/ ro ss ef orP
University of Puerto Rico School of Medicine
lati pcsiorHta iydteiPsrevinU
yr ecgi rrfut eSaniio hdi-C etPceS
San Pablo Medical Center
<[email protected]>
etneciV-oguL rD/koobdnaH gruSdeP - 2
CONTENT
NOIT CUD O.RITNI GN ID E E LLABNITSETNIORT S.AVG
scitsiretcar achiCgolois ylhaPtan o.eAN )n rob w eg Nn(i d e reI el Gpb.p AU
)nro b grw.neeBi wNdIo(e GLelb
.1 retaWmsilobateM )CE Ns(itilocoret ngEnizitorc e.N1
)d l irhe cd lgOn (id e reIe lGp. bpCU
stpec nsoeCtylortc eddlniE au.l2F ) rd.rgelDendiw ilh oIdOcLGe(elb
eruss ilFa n-A1
s n ro b w e lN au d iv i d n nIsinoitair a.VB mulucitrev isD’lekc e-M2
stn asfn nrsI o e.bfp1woyeTN s p-y3loP
sisopyl osPuotamone dlAailim a-F4
se sne ft esdcD oniHal oba t.e2M SREDROS ICDINEL PdS nYaRAIL I,BCITAP ECHITAERC N. AIPV
snrob wefesoNnop sleaRcig r.u3S
SNOIS EKLC EDN NDAA E.HII musiv isDaercnaP/saercn arPalun n.AA
yhtaponedahpm ylLacivr e.CA sititae r.cBnaP
sillocit rloaTtineg n.oBC
csittsay eC.rCcnaP
st st yclCuaDssolgor y.hCT s tcsiytC a.pDeH
ai syerr at.iAEliB
saluts itFfe llCaihcna r.BD aisalpo pyyrhai l.iFB
amor gcyiHt s.yEC t slyaChcodel o.hGC
esa ehscit Das r’.ctFSaC
S M dEEInLVGaBI OTRCP URT S.BIO II sisaihtilelo h.CH
),DnMamzt ineaWd r yonbJo(itcurt slbaOnitse tlnaItan ohoectNaor plpaAcigoL
sison e dtanSiase rltaAegahp o.sAE t ecnluoiDiBtaro fcriehPtap o.iIdI
a is al ah c.AB sainel pdssniAasotycore h,psSisotpone l,psst scyiCne l.pJS
se il am oln aAn ed ou D- ort s.aCG amua rcTinel p.SK
seila mcoinrA t.s1aG egahrrom elHaner d.AL
siso nceitrS o.l2yP .SIRIOVMUT
sn oi ta mr of lla aMn ed o.u 3D ro msu mt l .iAW
s ul u vl od Vnn ao it a to rl a. MD a mo ts al bo ru e.NB
sai s learntiA t s.eEt nI am oc ra soy mo db a.hC R
sue lmIuinoc e.MF s ro m ur Tev i.L D
. EsamotareT
es ae ssi 'dg nur ps hc s r .iGH srom unTaira v.OF
s ue ntAa rof re p .mHI
sn oi ta ci l p .uID selud odNiory h.TG
no it pe cs us su t.n JI
si ti ci dne p.p KA amohpm ysL’ttikr u.BH
noitcurtsbo-odu elsaPnitse tcniIno r.hLC SNOITAREDISN OLCAUXESRET Nd InCaIGOLOCEN Y.GIIIV
s tnaf nnsIinoiseh dlAaib a.LA
s.rMaozeB s tns ayiC r.aBvO
emordn ydsionicr a.CN
sred rdoestiadler-mui n.oOceM .C tsaerBsredrosiD
sue lmIuinoc e.M1 aisalprep ylHaner dlAatinegn o.CD
sitinotir emPuinoc e.M2
emordn ynsol occitsalpop ythf ed Lneamordn ygsu lmPuinoc e.M3 emordn ynSoitazinim erFalucits e.TE
noitse gyn dInogBie r.oPF sisenegs ylDadan odgex i.MF
TCEF ELDL ALWANIMOD B DAS NNAOITIDN OCCICARO H,TSAINR E.HVI emord nty cSnuaDirel l.üGM
sainr echitamgarhpa i.DA soplocortemor d.yHH
)keladhco Ba(inr ecHitamgarhpa ilDatinegn o-C1 SNOITAMROFL ALMATINEGN OLCATANE R.PXI
sainr eiHngagr o-M2 yr e lg. arAtueSF
s a in r el Ha ta i -H3 noitcur tlsabnOits elt an.tIBeF
seilamo ndA ugBn u.LB stce fl ellDaaWnimo dlba At.eCF
amesyhp mrEab olLatinegn o.C1 GN ID ADE ERT SE G G. UXS
noitartseuq eySranoml u.P2 gnida ecRificepS
noitamro fdliaoMtamo nceid tA.s3yC gnida elRareneG
t scyiCnegohcn o.r4B
xarohtoly h.CC
ameyp m.ED
xarohtomue nsPuoenatno p.SE
elecotamue n.PF
s ai nr ech ir ts ag i p d ens ait s edTednecsed n,Uselecord y,Hsainr elhaniug n.IG
st slyaCnitsai d.eHM
s a in r el ha c il i b m .U I
si sih cso rt sdeanlGa eco lah p.mJ O
sainr elHarom e.FK
etneciV-oguL rD/koobdnaH gruSdeP - 3
NOITCUDORTNI .I
scitsiretcarahC cigoloisyhP latanoeN .A
metabolismWater 1.
Wate r represents 70 to 80% of the body weight of the normal neonate and premature bab y
latoT .ylevitcepser .stisoped taf ssel evah serutamerp dna ,tnetnoc taf htiw ylesrevni seirav )WBT( retaw ydob
TBW is distributed into extracellular fluid (ECF) and intracellular fluid (ICF) compartment. The EC F
compartment si driht-eno eht WBT htiw muidos sa lapicnirp anions.as bicarbonatea nd chloride and cation,
driht-owt si tnemtrapmoc FCI ehT popwtriaittTNsnhhcBesc eaWwiitT t buphhmiomaeeeor l tnn a.'rb sao tleic
ne artxe dna hgih si watbeordy icnh antgegemmAbr ap ooiedwanrfytnntao heodetr.ef nu d areinedsc ee rgy
xe wen sih ot sutef eht fo ecnartne nopu srucco retaw ydob ni esaerced laudarg a si erehT .ecnetsixe eniretuart
imocnoc a htiw tnemtrapmoc diulf ralullecartxe eht dna tainntc retiaihnsnete r acellulfalruc iodm partmenTth.i s
amerp a htiw detpurretni si tfihs thetghrarenea lmtauetcrih iv se lya srueranf ebawocbdeoy Tr hnbe'i sr tthu.r e
adults an d heat loss is a major factor. Insensible water loss are from the lung (1/3) and skin (2/3) .
retaw )niks( lailehtipesnarT Inspeonassgtie-b.nl aiietnna clrd eweaicstrehec aaosnmedpms oa njeonrt t he is
phototheraanpdyw .arm(etrreasmd)pi,ea rnatt buordey aggees,t ationably affected is loss water
Neonata l renal function is generally adequate to meet the needs of the normal full-term infant but may b e
limited d uring periods of stress. Renal characteristics of newborns are a low glomerular filtration rate an d
dem ni aeru detimil( ytiliba noitartnecnoc uilnltaerrydtt eolihletmwcyteshahidorsekiur a mecman sh)Ttt hi eon.
neonate is me yllacilobat evitca dna noitcudorp fo etulos ot etercxe ni eht eniru si .hgih ehT yendik niht e
5( yllaitini L/msOm 004 tuoba ot etartnecnoc ylno nac nrobwen 00-60m0O sm/tLh feu ll-tercmo mparetd1o 2 00
a ,)tluda na rof L/msOm tnhde reforreeq uir2ec-sc4 / kg/uhrri pnreo ductictolone t arhree n saoll ultoea Tdh.e
oldcehrin ledea dbso1 cu-ct2/ kg/athanhrdde u 0 l.t5c -c1/ kg/hr.
ElectCaronondlcF yeltpuetissd 2.
Ce llular energy mediated active transport of electrolytes along membranes is the most importan t
hca fo msinahcem ievmaiannidgn tainnionrgvm oalclauo nmmdep osiftlociufooi mndp artmenItnsf.a cnatns
retain s odium but cannot excrete excessive sodium. Electrolytes requirements of the full-term neonate are :
2-1 muissatop ,yad/gk/qem 3-2 muidoS meq /kg/dacyh,l ori3md-ee5q /krgfa/olatd1facu oea0 tcif y0 /d k g/24
apprrefoqbldxueutaii ioimrdoclaet t:aytmhhn eeeu dn m tbos,f rule a wAesi ghotf. kg 10f irstth e for hrs
pr e ma t ur e s 120-1c5c0/ kg/h2r4s
neonate( st e rm ) 1c0c0/ kg/h2r4s
kg >10 Infants 10cc50cc0 0/+ k g /h2r 4s .
Spec ial need of preterm babies fluid therapy are: conservative approach, consider body weigh t
ticinot FCE dna ecnalab muidos ,segnahc voluasmnoedd iaunmdls oossdbusios utcamher tpeTot h iebyl ye.
areht suonevartni hgiH .gnidaolrevo broncehdnoytPapseDnuprAdllo,mac osponialaatir,ety ni ts to lead can py
ralucirtnevartni stresssurgical with amplify be can that load sodium a excrete to ability Impairehde morrhage.
itneter laner evissergorp( consideration:into take should requirements fluid daily of Estimationss odium). of on
( ,sessol lanitsetniortsag )2( ,sessol retaw yraniru )1( (drains).losses surgical (4) and losses, water insensible 3)
Bl ood Volumes estimates of help during surgical blood loss are: premature 85-100 cc/kg, term 8 5
cc/ kg, and infant 70-80 cc/kg. The degree of dehydration can be measured by clinical parameters such as :
ydob andmouth the of dfroynnteasnse lleoc,fdip erepcrruielpsahsteiirooannlo , f statet urgort,i ssuwee ight,
suonevartnI .tuptuo eniru whreenquiredb e will ands unregoenrayt ali na dvanmcaejso r the of one insu trition
.syad evif dnoyeb og lliw noitavrats fo doirep eht taht suoivbo si ti
Oral feedin g is the best method and breast is best source. Newborn infants requires 100-20 0
c ,sserts gnirud desaercni si sihT .htworg lamron rof yad/gk/seirolac intfoMreliascdnuaut,imnri madgou. enm r,y
qer yliad uiremean2rtg-e m3 / pokrfgo tei1n0,- g1m5/ cokafgr bohydraatsnemd a almlo ueonsfts entifaalt ty
.sdica
snrobweN laudividnI ni snoitairaV .B
TNy1eop.wfe b so Irnnfsa nts
skeew 83 fo ega lanoitatseg a htiw tnafni ezis-lluf ,mret-lluf ehT )a 2500than greater weight body a and
grams -)AGAT( yeht deviecer etauqeda eniretuartni ,noitirtun dessap lla latef sksat dna riehtigoloisyhp c
fun snoitc are predictable. b) The preterm infant with a gestational age below 38 weeks and a birth weigh t
ATerP( ega taht rof etairporppa smTahlelc -G)fA o)r;- gestatigoensatliaao-n(w tvafSiiaegaGtogrenAhne t) a l
eb thgiew ydob a dna skeew 83 2gl5rso0ahuw0maf ssf- eg rreordwe tthca ormduAbat itiedninr)ao o tno.i f on
pi(rt.cagsaehe)n(efmlite.,dbsoasine , )trloswfr a l hamt on i tao gnea.l
etneciV-oguL rD/koobdnaH gruSdeP - 4
yltnacifingis tsom taht citsiretcarahc ehT stiamtmeaturteh e is infparnett ermt he ofs urvivatlh ea ffects
of th e respiratory system. Between 27 and 28 weeks of gestation (900-1000 grams), anatomic lun g
h tnempoleved skeew 23 ot 03 retfa ylno si tI .elbissop si lavivrus eniretuartxe taht tnetxe eht ot dessergorp sa
of gestat ion that true alveoli are present. Once there is adequate lung tissue, the critical factor that decide s
extra eniretu noitatpada dna lavivrus fo eht mreterp tnafni si sih seitilibapac ot ecudorp ehtcir-dipilohpsohp h
epithelrieusmp.iratory the lines that surfactanmta terial,
DefeHnossMetes atnadb o2l.i c
i nibolgomeh fo stcudorp nwodkaerb eht fo gnildnaH diafalf ssio c tuptfalrhosteerk m atiunrfea Tnhte.
gujnoc ot revil erutammi eht fo ytiliba theansdh ort,i s celbll oodr ed the of spanl ifer tehdeub cieildsi, ra utbei n
bilirubin daol detneserp ot eht noitalucric aiv eht citapehoretne etuor si .desaercni "cigoloisyhP" ecidnuajsi ,
eht ni rehgih ,erofereht ipnplrfaeoeanrntp ndsageet if err sormiUtr ons df .o rtunatietmlhmyea, tb urhraaeis n
fo stceffe cixotoruen eht ot ytilibitpecsus desaercni na unclooenhfvji eugblghisa lk ti eerrdaun nbidic cnta,en rus
bilirubin.of level low relatively a at baby preterm the in develop
Ot her problems affecting the baby include the rapid development of hypoglycemia (35 mg%) ,
opyh chaylpaconeptdmdoh ieoeavNrr eelmaglwyi lhob auapo.cver oednn se ogedsneyepassentindesd m s,
a srh 3-2 detelped( serots negocylg revil morf sisylocylg no enntbuaeitnfrrrdtati Ielhtmr )im i oannctf.aua nrnet s
develop hy perglycemia from reduced insulin response to glucose causing intraventricular hemorrhage an d
glycosuria. Th e preterm and surgical neonate is more prone to hypocalcemia due to reduced stores, rena l
yh evitaler dna ,ytirutammi psojepiiatzrlctSuaeaaeayrtvnlrfrmehedcieepsyl int (trsueahoo)mslimi. s gsd h i sm
wiintchr emausstecoC lnaeel .cm iauimnm tge5/n0kai gns/c dea y.
Huma n beings are homeothermic organisms because of thermoregulation. This equilibrium i s
maintained by a delicate balance between heat produced and heal lost. Heat production mechanisms are :
voluntary elcsum ytivitca gnisaercni cilobatem ,sdnamed yratnulovni elcsum ytivitca )gnirevihs( dnanon -
.)taf nworb gnizilobatem( gnirevihs He alto sosc curfsr ohme aftl ofwr ocme nteotrfhb eo dttyohs eu rfacaen d
from the surf eca ot eht tnemnorivne yb ,noitaropave ,noitcudnoc noitcevnoc dna .noitaidar erehT sia n
aicossa hypothermia.to prone is neonate surgical The NICU's. the in mortality and hypothermia between tion
Infant prod ecu taeh yb gnisaercni cilobatem ytivitca dna gnisu nworb .taf woleB eht C°53 ehtrobwen n
e x ,aimelakrepyh ,aimecylgopyh ,sisodica cilobatem ,aidracydarb ,noitaripser desserped ,edutissal secneirep
emordnys yrujni dloc latanoen( airugilo dna NUB detavele Fpartceht)cao.itr p sfi utptrarhttoeheabse rleree :ms
prem ,ytiruta degnolorp ,yregrus dna detarecsive lewob .)sisihcsortsag( lacitcarP snoitaredisnoc otiatniam n
irud sesag tnalahni detaeh dna deifidimuh fo esu eht era lortnoc erutarepmet NICUall duringa naensdt hesniga ,
thermistsosmerker-icvanhoc a-tnciiovsnawmtti.ret odhl heaterr adiant usep rocedures
oh s'nrobwen ehT defsetan gsaeiisnn fsetgc eatnrieeor nsa ulcflhftymaihm elceoetli stooeet f nn gte
moderate b acterial insults, but may not be able to meet a major insult. Total complement activity is 50% o f
rtnecnoc nidreporp dna ,B rotcaf ,xelpmoc 5C,4C,3C .slevel stluda acdoutmlhpitean. tr loioa swlo saanort ei on
.tnesba si ,atnecalp eht ssap ton seod ti ecnis ,MgI
Su3r-g iRceasNlpe oownfbs oer ns
The endocrine and metabolic response to surgical stress in newborns (NB) is characterized b y
catab olic metabolism. An initial elevation in cathecolamines, cortisol and endorphins upon stimulation b y
suoixon stimoucldcieu fare smn;es ceh aotnrhoigefsa m mnot ibosi ml sitzoeer needrr egsye rvfenoser,wm
msilobatac ralullec trats dna seno ,dehsinimid si efil fo keew tsrif eht gnirud ssenevisnopser naidacric lositroC .
due to inmaturation of the adrenal gland. Cortisol is responsible for protein breakdown, release o f
gluconeogenic amino acids from muscle, and fat lipolysis with release of fatty acids. Glucagon secretion i s
si esaercni nilusni amsalP .desaercni anabolicits troe sistancea alhtyhpeoefurfggehlc yttc,he em ic to reflex a
functio n si .tneserp gniruD lacigrus sserts BN esaeler ,esoculg yttaf ,sdica enotek ,seidob dna onimasdica ;
ne ydob teem ot yrassecen inmcerteodaafpebs toEmoeisaal mtrnieoldc piys en n.pr e aaeertdreisgnv yte e ral
noitirtun can result in significant rate of weight gain due to solid tissue and water accumulation. Factor s
correla gnit with a prolonged catabolic response during surgery are: the degree of neuroendocrinologica l
fo noitarud ,noitarutam operastbuaillrmootooogofnysopfiu ,psdr cn e, oat cl e dseuuxrrotegfe,ti n rctaa ulm a,
and associated conditions (hypothermia, prematurity, etc.). They could be detrimental due to the limiNtBe d
sevreser of mgnmeruoahtaotrtiaddwrgugbaeibtiatrhaopmmyhenha nltaap ,n etdianfo t i ctdtsso isee,no r n
NB. in response such suppress can fentanyl and halothane as such Anesthetics birth.
SNOISEL KCEN DNA DAEH .II
etneciV-oguL rD/koobdnaH gruSdeP - 5
yhtaponedahpmyL lacivreC .A
An enlarg ed lymph node is the most common neck mass in children. Most are anterior to th e
ausu eht si noitcefnI .elcsum diotsamodielconrets encloaafur sglepe emmvreoefisnntoritti ras;ho lat sl n .odg y
idnambus evitaruppus etucA orpharyngitis by preceded is yrs), mo-3 (6 childhood early in occur adenitis bular
dna gnillews ,amehtyre spoleved dlihc eht ,IRU Chrdornaiicnage.aa nndt ibioticissm anagemenactne dl lulitis,
w 3 >( edon tnetsisrep :sitineda forcm, 1 < if tx tGoennnsoseso irkoflna.ltlol,i.anal t r-nyam)td ro,e yb n,id leer ,
biopsy. do matted or hard clustered, growth, rapid with sizes cm 2 above nodes
Ot her sesuac :era )1( lairetcabocyM -sitineda lacipyta SIAM( ,)xelpmoc ,nellows rednet-non ,
nor-inflamed, snioisic x,ets enti kesvitis op desuac -sitineda hctarcS-taC )2( .eulav on fo si xtomehc ,evitaruc
yb silleF .A tnemelpmoc evitisop ,snettik yb dettimsnart , nodes,regional fluctuant tender, minimally test, fixation
sp ontaneous resolution. (3) Hodgkin's disease mostly teenager and young adults, continuing growth, non -
.citsongaid si yspoib ,ssol thgiew ot detaicossa ,edon rednet
TorticollisCongenital B.
latinegnoC mudsitcsocuorhlrataad icrrescea rhiorct osmlvthr ublieetsyicr omec saifonl lz sie etns g,
it dna ,elcsum )MCS( diotsamodielconrets eht ylnommoc tluser eht si sihT .edis etisoppo eht ot daeh eht fo gnitl
o sisorbif laisymodne fo affectedside the and position birth between relationship a is There muscle. SCM the f
yb the contracture. Congenital torticollis caupsleasg:i occreap(nhaia olfyad ceifaolr miftaysa)cs,iy amlm etry
(hemihy poplasia), scoliosis and atrophy of the ipsilateral trapezius muscle if not corrected. Torticollis ca n
develop at any age, although is more common during the first six months of lifeT.hS eCm Mu sclceaba ne
suorbif mass, or a palpable tumor 1-3 cm owt yb deifitnedi si elcsum eht fo ecnatsbus eht nihtiw retemaid ni
m ni evitavresnoc si tnemeganaM .ega fo skeew eerht ot naem a ’sesicrexe yparehtoisyhp ylrae gnisu sesac tso
noitarud of three ismotion of restriction of severity The motion. of range neck passive full achieve to months
the stronpgreestdtri eocaftt odmrue rnatt Tichohonis.lef wd airmiteelhndde t eitdhvch eeaeorll rao ppym ent
faosfch ieamli hypoplasshiouaun lddes rugrog itcraalnm sSuetCschMctoe lif eo .n
TCh.y roglossDauClcy ts ts
si )CDT( tsyc tcud lassolgoryhT thmeo scto mmocno ngenitaaln teriomri dlinnee cmka suss uall(y2 /3
of cases) presenting before the second delcioSaffyde me.p taaovpafmewpnotsaroie auh taftagre g hre e
ta ssam citsyc a fo ecnaraeppa neddus swaplrltoaootnwnrdigu nwusgiei.mt oohnv lienvge nle ck of anglet he
Males are more commonly affected than females. TDC is an embryologic anomaly arising from epithelia l
ved eht fo tnecsed retfa tfel tnanmer elopintgh yroifdr otmhf eo ramecne cumT.hl ei ninicgsu boidalc,o lumnar
ot detaicossa si CDT .muilehtipe deifitartsoduesp ro malignancy.of probability slight a and infectiodni scomfort,
ssam eht taht tnemucod ot si tnemeriuqer evitcetorp yllagel A .lacisyhp si sisongaiD .dnalg dioryht cipotce ton si
wteb tsyc a wohs lliw smargonoS diaimne cvwtmaie rtri4h,sa a obn0nld.oee 4ge rna apphpieca nroaanndc e
correl noita with pathological findings of infection or inflammation. Once infected surgical excision is mor e
s’knurtsiS si tnemeganaM .esaercni lliw ecnerrucer dna tluciffid tcud fo noitceser htiw tsyc fo noisicxE :noitarepo
ec eht htiw gnola ntraplo rtioohnfy oibdo n(meai nimuo1mf0 -1moh5mfy oibdo nseh oulbrdee moveda)n d
rus elcsum emos intospreads bone hyoid the above duct single of length (the ductulesp roximal the rounding
)mucec nemarof eht hcaorppa ti sa ilutcud ynam tsetaerg ehT .ainydognyrahp esuac nac noitcessid evisnetxE .
.noitatneserp demalfni-non laitini ta yregrus si eruc rof ytinutroppo rehtruf rof rotcaf ksir a si noisicxe etauqedanI
recurrence.
FistBCurllaeanfscth iDa.l
if tfelc laihcnarB braan3pcrphdedai muratbralorit ynuo1gsgs eton tr(sehiBtsefgCui riFlson)ama s t e
ilamonA .kcen dna daeh eht fo eotsfh2 enb dr anchiacll efatrbf eyat rhm eo scto mmonlfyo undT.h ecyab ne
fi tcart sunis ro( salutsiF .salutsif ro tcart sunis a ,tsyc a cutasnmeaoluls thadebsiml ssipenlldavlyeey ns)d they
conrets eht fo redrob driht rewol roiretna eht gnola gninepo leidomastmouisdcc loem,m unicaptreosx imawliltyh
th e rallisnot ,eassof dna nac niard avilas ro a diocum .noiterces tnemeganaM stsisnoc fo noisicxecnis e
noitcefni ot dael yam eganiard tneiciffeni fotsosnas!i)llatrh e to (up tract the adliosnsge cttihoant found have I .
retfa dehsilpmocca ylisae dna ylefas eb nac preventwill This in-place. wire guide small a with tract the probing
dna slessev ,sevren ot yrujni acco mpplleaia ssha nstmlayl slceOarcr c.a siosneacaslo tlneydp ladidnecri sion
,nommocnu era FCB ts1 .deriuqer eb lliw kcen eht ni lo cateatdtha en glotefhm ea ndiblea,nc do mmunicating
htiw the ,erar yrev era FCB dr3 .evren laicsaf eht htiw noitaicossa esolc a evah yehT .lanac yrotidua lanretxe
infections.neck recurrent or thyroiditis acute of cause a be may and sinus piriform the into run
HygromCaystic E.
Cystic hygr oma (CH) is an uncommon congenital lesion of the lymphatic system appearing as a
etneciV-oguL rD/koobdnaH gruSdeP - 6
olitlum extensivewith associated occasionally region, neck back the in commonly most cavity filled fluid cular
yawria fo tnemevlovni withcommunicate to lymphatics of failure intrauterine is etiology The structures. vital or
th e venous system. Prenatal diagnosis can be done during the first trimester of pregnancy as a huge nec k
tumor. Differential diagnosis includes teratomas, encephalocele, hemangiomas, etc. There is a stron g
xd latanerp neewteb noitalerroc aTnudr ners'ysn dr5o(0m>%se )t ,r ucturdaelf ec(tNso onans'ysn dromaen)d
chromosomic anomalies (13, 18, 21). Early diagnosis (< 30 wk gestation) is commonly esoht ot detaicossa
enummi-non ,seilamona odd(uiSeftshpaecmayottoandblnhamldruit)le otklra. peeen slsge ysro ieusss s ion
can expl ain webbed neck of Turner and Noonan's children. Prenatal dx should be followed by cytogeneti c
hcun ro ,sisetnecoinma ,gnilpmas suolliv cinoirohc :sisylana afll uicde lolb tainefdr otmhCi eHt seltdfoe termine
pytoyrak latef yraitret ni dereviled eb dluohs )skw 03>( sisongaid etaL .ycnangerp fo gnilesnuoc edivorp dna e
syd htiw laed ot eraperp retnec sebceufasbropniheeroero deswTwu atdbhaltnnyooeydodasfr c tp nian.ale a
isel eguh ni gnipmalc droc )senegoyp succocotpertS fo tcudorp dezilihpoyl( 234KO fo noitcejni citsycartnI .sno
t del dna demalfni emoceb ot samoignahpmyl )samorgyh( citsyc desuac withoutlesion the of cure subsequent o
.stceffe edis
SCcarFta.D t icshe ase
a yb dettimsnart noitidnoc detimil-fles a si )DSC( esaesiD hctarcS taC Bartonelslpae ci(eRso chalimaea
henselae) present in unaffected kitten paws. Following inoculation by a scratch and one to two weeks o f
noitabucni period, malaise, fever, headache, anorexia and swelling of the regional lymph nodes follow. Th e
yhtaponeda generally develops in the upper extremity (epitrochlear, axilla) or head/neck areas, is minimall y
tender dna . nn o anipcatoialdueetv Mceeudglaf si 41 srae yh ttiswehgih tenthcahlnie lsdsir ne nra atttea ck
fo sraey papule(characteristic exam physical signs, symptoms, of presence the on relies diagnosis The age.
fo etis eht ta Bartonellafor assay immunofluorescent positive a and cat, a to exposure of history scratch), the
antibodie .s Most patients with clinically diagnosed CSD developed an immunologic response to Bartonell a
speci .se Conservative symptomatic management is recommended for most children since the node wil l
ppasid yllautneve era scitoibitnA .gnitaivella si sedon tnautculf fo noitaripsa 'sesac rehto nI .ylsuoenatnops rae
recommdsecuOenarvvdgpsieeeorenrrdoosgae dg. il .n slo sis
SMELBORP EVITCURTSBO .III
NOITCURTSBO LANITSETNI LATANOEN OT HCAORPPA LACIGOL
:yb deraperP © DM ,namztieW .J nadroJ
USACalifornia,A ngeles, Los
Symptomsand Signs
.lamronba syawla si gnitimov suoiliB .1
Abddiosm(tis2peanc.onbaa stdlpsio hiomobneil nde ).
De3lp.aam ysnseecosocdao afo,nrg n t eiy u m.
mother.in Polyhydramnios 4.
syndDroowmne's 5.
yrotsih ylimaF .6
esaesid s'gnurpshcsriH .a
Diambobet.th iecr
Jce.j unaatlr esia
Work-u(pL ogicaalp proach)
"non-bseu rpmgraioycbt alhlee"tm .h amti nd in kept be musstt biuetdi inegidi s,n fatnhWteh ile1 .
a. sispeS fo eht nrobwen htiw detaicossa sueli si eht tsom tnatropmi esuac fo lacigrus-nonuoilib s
.noitnetsid lanimodba dna gnitimov
snoisel lainarcartnI .b
sulahpecordyH .I
iSiu.b durhaelm orrhage
.aimeru htiw detaicossa esaesid laneR .c
sisenega laneR .I
etneciV-oguL rD/koobdnaH gruSdeP - 7
esaesid citsycyloP .ii
.sisorhpenordyh ereves htiw detaicossa eb yam hcihw seilamona tcart yraniru rehtO .iii
P2l.a rione ntgenogratomahfsbe d omen.
bowel.small distal in gas obstruction-nion testinal high complete in Diagnostic a.
duDoboodiuubenbbsIn blt.aler le u ction.
atijrdneeudjsoiubidcneaeaay.ntlouel nmsod o fpisl ledg as Few ii.
oibnsttersutcitnliaoolwn .of form soimned ichaotuerss ) 24( requilroeosp sf illed gas Many b.
aiserta laelI .I
i muinoceM .ii leuunsf(oarnt muinsantoem er)-odbisistnmstthtathrielaeucbsll ockyt ft i inoen
undigestmeedc onium.
iMieic.o npisluyumng d rome-obstmpreolucfucoca gtno ob iilfyouo nmn .
iSvm.a llelcf otl soynn drome.
.mutcer eht htiw gnitrats noloc fo sisonoilgnaga latinegnoc-esaesid s'gnurpshcsriH .v
.aiserta cinoloC .iv
c. May b e cificepsnon ni secnatsni fo noitatorlam fo eht .senitsetni sihT sisongaid tsum syawlab e
.gnitimov suoilib denialpxenu htiw setanoen ni deredisnoc
Cadl.c ificationsstd-oiuammrfteeie l m ntiegafc leo( p nwairitabseuhsd)sime o en mn etn .
.noitcurtsbo lanitsetni wol fo sepyt suoirav eht etaitnereffid lliw amene tsartnoC .3
Mai.c rocolon-compleotbes tructitooshfnme a blolw el.
Mbe.c onipulsmuy gn drome-coldoinl atperdo xiianmtntao rl a luminmaals s.
newborn.the in reliable not diagnostic, be to appear may it disease-although Hirschsprung's c.
Sdm.a llelcf otl soynn drome-coldoinl attteshodpe l enfilce xurteh,be enc omneasr row.
ni eciohc fo erudecorp eht -.I.G reppU .4 amene tsartnoc a tsap eht nI .senitsetni eht fo noitatorlam gnisongaid
citsongaid eht eb ot thguoht saw cihtonoeifsisn tct mae an olcfre ost acttaebahiscuneocutd nem n dcionlgo n
intestines.the of malrotation with child or infant an in position normal in be can
s eht gnidaer ni tnetepmoc tsigolohtap a -yspoib latceR .5 grantedf.or taken be not should aensds entiails lides
a. Suction biopsy of the rectal mucosa and submucosa- best screening procedure to rule ou t
erp era sllec noilgnag( esaesid s'gnurpshcsriH .sdnah decneirepxe ni citsongaid si dna ,)asocumbus eht ni tnes
F .b ro citsongaid-non si yspoib noitcus eht fi yrassecen eb yam llaw latcer eht fo yspoib ssenkciht llu
htap eht fi .nemiceps yspoib noitcus a no sisonoilgnaga fo sisongaid eht ekam ot elbanu ro gnilliwnu si tsigolo
centers. most in biopsys uction the by replaced been has and infant small the in difficult is procedureT his
muinocem fo egassap deyaled evah ohw snrobwen llA .c amene tsartnoc suoicipsus a htiw detaicossa
tiW .asocumbus dna asocum latcer eht fo yspoib noitcus a evah dluohs esaesid s'gnurpshcsriH ,euqinhcet siht h
lliw "cured"imse coniuomfp adesencsltoaaemgyrwpeeoil dIcti fohci l asit teids .i t befdoeiraaerg lnyo sbeed
by rectal stimulation(suppository, thermometer, or finger), it must be kept in mind that the diagnosis o f
Hirschsprung's re h.r t yoyet etshon s ip Wnofall o sioeliaieitsibbh cititaudssssop rectdiuosmbn eef otrhee
t no sdneped emoh seog tnafni beforebiopsy rectal the do to is action of course safe the but setting clinical he
enterocolitis. with trouble into gets infant the before call not may Parents discharge.
sac lla ni detacidni ylbaborp si mutcer eht fo yspoib noitcuS .d eossfc o a llemde coniupml usgy ndrome
or small left colon syndrome. If the suction biopsy is not done, the infant must be observed for recurren t
lanitsetniortsag symptoms. A breast-fed infant who proloHani grhesfadcoshr bs yp""rgd ueicntsag en'a ss e
timpeoe.fr iod
6C.o ncludincgo mments:
The new nrob detcepsus fo gnivah lanitsetni noitcurtsbo dluohs eb deiduts ni a lacigol pets ybets p
i tI .rennam issurgery before problem surgical a has infant the that established definitely be it that important s
fo secnatsni ni tluciffid ton yllausu si sihT .demrofrep complehtiesg mha blolw oebls tructiwoohrnpe lna fiinl ms
nemodba eht fo ashowienngce omnat rastth e obwsittrhbu ocwteilos nm aldli stal ac alcainfdsi/hcooarwt ion
microcolodoaner f initmea lrotatiootnfh c eo lo(nc ecuiumnp pemri d-abdomeolnre futp peqru adrant).
hW sdmiaslttlahle in gas oibbstso shtwmerearhbulleiuc l gtt h i oans uggaoerffseip t llimavsie ne n
etneciV-oguL rD/koobdnaH gruSdeP - 8
bo wel, an upper GI rather than a contrast enema should be performed. It is critically important that th e
yawla eb senitsetni eht fo noitatorlam fo sisongaid .gnitimov suoilib htiw etanoen a ni tuo delur dna deredisnoc s
Prompt r noitingoce dna tnemtaert fo noitatorlam fo eht senitsetni hcihw si netfo detaicossa htiw augdim t
resection.bowel small massive a with associated problems the of consequences dire the avoids volvulus
Mista kes are frequently made when the contrast enema is interpreted as normal, meconium plu g
synd rome, small left colon syndrome or Hirschsprung's disease. In all of these clinical situations, a suctio n
decorp gnineercs tnellecxe na si mutcer eht fo yspoib Hiprrsecdshiessnpetraa,urs neeg 'cse glalnsg lionI f ure.
is ruled ou t dna eht tnafni ylbaborp sah a lacigrus-non .sisongaid fI noilgnag sllec era ,tnesba eht txenets p
fI .gnittes dna erutcip lacinilc eht no sdneped ,noitaterpretni eht fo tnedifnoc dna decneirepxe si tsigolohtap eht
saesid s'gnurpshcsriH fo sisongaid eht absencethe aboutd oubt any is there coInff idweintche . made be can e
of ganglion cells in the suction biopsy, a full thickness biopsy of the rectum (a difficult technical procedur e
tehtsena lareneg a gniriuqer eht eb ot deveileb si esaesid s'gnurpshcsriH fI .eussi eht elttes ot enod eb nac )ci
desongaid eb tsum ti ,melborp surgeryof time the at becausuepo opne ratedi s infanhti tshteo bleofgoircea lly
the site of obstruction may not be apparent and the abdomen may be closed because no obvious site o f
.dnuof si noitcurtsbo
rif eht ni msidioryhtopyH Himarissmpciceahcacls nltlp is drfiiuensn om egfota' nhsstre he set o two st
nrobericmotapaals l ey fx.ocre pt
lanedoud taht si rebmemer ot tniop tnatropmi rehtonA adtirfaef isesir daei nste fajrseoejmi u loneraa ll
aiserta in terms of their cause. Jejunal and ileal atresia occur as a result of a vascular accident in the smal l
bowel me yretnes gnirud latef .efil ,yltneuqesnoC ereht si a ylevitaler wol ecnedicni fo rehtoatinegnoc l
.sisorbif citsyc rof tpecxe seilamona Duodenal aiserta si atn eerseafefsiidd ni taht ereht si a yrevgih h
sa fo ecnedicni sociaatneodm alie(sD-o-w sny'nsd roimmep,e rforaantruees an,na olm aliceosn,g enihteaalr t
.).cte ,esaesid
Malrotat ion of the intestines and Hirschsprung’s disease must be ruled out before a newborn wit h
nialpxenu tpoarentosn rely tou nsafeb e can It homes.e anbvtdabdo iniomsdlimit/isiteoo ninruanet slgdi on
observe t heir infant for problems resulting from the above conditions. If diagnosed late, malrotation of th e
intestHiionrres sc hsprundgi’sse bcaeascnelo t imhfere e aterneolislrinipuo fgnrlne otg b lems.
alutsif laegahpose-oehcarT o/a aisertA laegahposE .A
ygoloyrbmE .1
The trachea dna sugahpose yllaitini nigeb sa a lartnev mulucitrevid fo eht tugerof gnirud ehtriht d
in eniretuart week of life. A proliferation of endodermal cells appears on the lateral aspect of this growin g
otni tugerof eht edivid lliw sessam llec esehT .mulucitrevid treasaconh pdeh aa tgueWbaheles it.nh teerr ruption
ehcart gnirud ro ,seilamona laegahpose-oehcart ot sdael tneve lamron siht fo esophagtuhse of atregsrioaw th al
proven.be to remnantt rachea the to esophagus the of fixatfiiosnt ulous of becauser esults
Classification2.
tsid htiw AE aTlE( F8 7)t%-hm eo scto mmoann omalyt,hNt eGu bceo ileaTdt4 -l5e vealng daw si ll
be seen in the KUB. EA without TEF (8%) - pure esophageal atresia, NG coiled at T4-5 level with airles s
a b withEA (<1%). TEF proximal with EA fistula. tracheo-esophageal pure - (4%) atresia without TEF domen.
(<1%) TEF distal anpdr oximal
eht fo %6-4 sa srucco )FET( alutsif laegahpose-oehcart detalosi latinegnoC esophagusthe of disorders
gnignirb problems during early diagnosis and management. More than H-type ytiuqilbo eht ot eud ,epyt-N si
t )ihcnorb niam ro anirac( aehcart morf alutsif eht fo esopohf ait(sgghsiaeueednar eeale t )o lmetivhceeaal tl ly
of the neck root (C7-T1). Pressure changes between both structure can cause entrance of air into th e
ht otni tnetnoc laegahpose ro ,sugahpose tracclTethih henumeaisa .c,anf a wiolafrb remeesu tswattet h iaotn
early dia sisong :era ,sisonayc gnihguoc dna gnikohc htiw ,sgnideef tnerrucer tsehc ,snoitcefninetsisrep t
ngaiD .noitavilasrepyh dna ,ria htiw noisnetsid lanitsetniortsag wceolnlifao-seiw sd sriioomtsnpeh ehd a gogram,
ET eht fo level hsilbatse ,setar sseccus hgih( margogahpose-oediv ro FB)a.rtt iihruneam c hceocauba leud s ed
yb ngoni it raeurhditpsa step.diagnostic next the be should bronchoscopy doubt radiologic Upon procedure.
Any delay in su yregr si yllareneg eud ot yaled ni sisongaid rehtar naht yaled ni .noitatneserpnemeganaM t
consists o f surgical closure of the TEF through a right cervical approach. Hint: a small guide-wire threade d
pocsohcnorb gnirud alutsif eht hguorht soomhbfmaee yeyl W po.r kttiihrnneag c heo-esophagegarlo ocvaen
rapraer.Raciceloslcyrv oausdorsfri ceutrsawlcree.liauern tnrrt cheyrhe rnee vgn eet a tloi njcuaruys e
Diag3n.co hsatriacc teristics:
etneciV-oguL rD/koobdnaH gruSdeP - 9
eewteb ees eW .shtrib evil 0052 yreve ni eno si ecnedicni ehT cirtaideP ytisrevinU eht ta raey rep 01-8 n
tom ehT .latipsoH be(May fluid. amniotic swallow to unable is fetus the since polyhydramnios show might her
resp onsible for early delivery). Polyhydramnios is most commonly seen in pure esophageal atresia type .
s evissecxE .deef tsrif htiw noitatigruger dna gnihguoc ,gnikohC ssap ot ytilibanI .sgnideef htiw sisonayc ,noitavila
feeding tube into the stomach. Contrast studies (UGIS, esophagogram) are rarely needed, and of potentia l
dis retsa (aspiration of contrast material). Abdominal films should be obtained to rule out the occurrence o f
detaicossa gastrointestinal anomalies. Isolated TEF is more difficult to diagnose and may require repeate d
lateersaolp hagograbmrso,n chosceaosnpodyp hagoscopy.
tnemeganaM .4
moced dna ssertsid yrotaripser ,secnabrutsid esab-dica ,noitardyhed tcerroC pprreosxesis moaplh ageal
(pRoeamuptEsocluvsVrhobafoAae geloccCso)l)urioTsr:e.a anaEo ttdsRceeis Li( dtu a3 ict ohin osn
- V bifidaspinhae mivertebrae,i .e. anomalies ertebral
- A nmaall formatioin.sie m.p erforaatneu s
- C ardmiaalcf ormatiiVATo.SSeneDDts.,,r alFoaglyl ot
- T racheo- E asscooctnihdaeit teidoo fn s)one bseo (fpmihusastgtue laal
- R .cte ,aidapsopyh ,yendik tnesba .e.i seitimrofed lane
- L aisalpsyd bmi
Early s urgical repair (transpleural or extrapleural) for those babies with no evidence of pneumonia ,
adequate thgiew 0021>( )mg dna on tnacifingis detaicossa .seilamona seibaB htiw yaR-X-tsehCvitisop e
,sgnidnif but adequate ABG's can also be primarily repaired. Delayed repair (gastrostomy first) for all othe r
patients. Surgical repair consist of a 4th intercostal space right muscle-sparing thoracotomy (side o f
o hcra citroa fo edis ot laretalartnoc si ymotocaroht patfi enctl)o,ts rouafrc eh eo-esophagfeiaslt paurnlidam ary
esophago-erseaopfpatdhieaarryg.7 so-E s1sdt0ooo pnmheya .ig so gram
Com snoitacilp after surgery are: Anastomotic leak, anastomotic stricture, gastroesophageal reflux ,
tracheomalac ,ai and recurrent TEF. The three most common anastomotic complications are in order o f
frequency: stricture, leakage and recurrent TEF. Recurrent TEF after surgical repair for esophageal atresi a
mixorppa ni srucco ate3l-cy1oa 5fs% eT se.n staiohnonean s tomosfeosl lolwbeeyad k amllgaetoeyaoc d a l
nahne senil erutus htob fo egakaerb htiw noitammalfni crctheihaocnenfug c r erTOe eEnsnFctt.ea blishtehde,
alutsif allows saliva and food into the trachea, hence tnerrucer htiw sesira sisongaid siht fo noicipsus lacinilc
ssa smotpmys yrotaripser htiw demrifnoc si sisongaiD .aiserta laegahpose fo riaper retfa sgnideef htiw detaico
o sugahpose eht fo yhpargoidarenic devorp sah tub ,suodrazah yrev si ymotocaroht dnoces A .ypocsohcnorb r
ot be the meofsfte ctmiecvtlretthoe ohosc edeu rrTeEpEnilFttep.a hue oerrrrai lc ardfiwleaiafllpf l e ctively
etalosi eht erutus .enil laidracireP palf si reisae ot ,ezilibom sedivorp tneiciffus eussit ot esu dna sevresa s
template for ingrowth of new mucosa should leakage occur. Other alternatives are endoscopic diatherm y
deposition.glue fibrin or coagulation, laser obliteration,
c nerdlihc ni sisonets laegahposE abocnefo ngenita(l5 %om)ro scto mmonlayc quirenda tur(e9 5%).
Acquired sisonets si eht tluser fo deriaper laegahpose ,aiserta citsuac ,yrujni gnitartenep yrujni roulfer x
ac )SEC( sisonets laegahpose latinegnoC .sitigahpose bnte h ree sulomtafe mbranoudsi aphragms,e gmental
hype yhportr of the muscularis and submucosal layer (submucosal fibrosis), or presence of ectopi c
driht latsid dna elddim eht tceffa ylnommoc tsom SEC .tser laihcnorboehcart etshooepf hr aaagnrcudeas lu ys e
nitimov eb nac smotpmyS .doirep latanoen eht ni smotpmys impactionr,feogoudr gitaftoioodun,n, d igested of g
s gniwollaws ytluciffid dna erar yrev si sugahpose eht fo driht reppu eht gnitceffa SEC .evirht ot eruliaf dna dilo
ys yrotaripser ecudorp yllausu atresiaEsophageailn fectionrse.s piratory repeated and stridor as such mptoms
is a detaicoss htiw driht-eno fo sesac fo .SEC oT hsilbatse a sisongaid noitagitsevni sah otdulcni e
cric htooms ,gnol ylevitaler( margogahpose gnirotinom Hp ,yspoib htiw ypocsogahpose ,)gniworran laitnerefmu
oitingoceR .yrtemonam sesac detceles ni dna paveswtirlilc ttuhreec ausetdh aeftta cicootrlororeg cittch e of n
yaw eht adfeoqrmu aantmaeag nefiwamosiCger tEenchSddte i .fl uahlty adotrrio osntb aatlidlcio loant ation,
hw intr(affciotnbrtaer hbeooldmhseeuye dsapba cneenudr cal rtasaewrwstrsioieo elptsmclhh iot y lsi)eio sn
harbtorraicnhgtep rorabetcorshhfoeee nin ortcncMbeohteors ird sotaautnslcer ac.c t erh aaseisbt ael.lse
aisalahcA .B
rosid rotom laegahpose nommocnu na si nerdlihc ni aisalahcA lacigoloidar ,lacinilc yb dehsiugnitsid red
nedicnI .serutaef scirtemonam dna ofyears 14 under population 100,000 per cases/year 0.1 in estimated is ce
etcarahc si noitatneserp lacinilC .ega dna niap tsehc ,ssol thgiew ,noitatigruger ,aigahpsyd evissergorp yb dezir
nafnI .hguoc lanrutcon yb demrifnoc dna wollaws muirab yb dehsilbatse si sisongaiD .evirht ot eruliaf tibihxe st
aegahpose 'swohs wollaws aB .seiduts ytilitom dna yrtemonam dilalt atmiootscniama,llal itlitealbyr e aartnido n
kaeb-drib( peristalntoincp-r esspshuirnec,t erE -G elevartceeavdrMe daainlojos-um enesctotrpiy)ho ang.e al
ahpose rewol fo noitaxaler deliaf dna noitcartnoc laegahpose swVaildleousowppfiohlnniug no.cgr teoeasrlc opy
can be stchrhieeeen esol noofpifp n hga gmeoatdloi rsso rdeErsso.p hagpenaelu mabtailcld oiolna tatiison
not an effectiv e method of treatment in children due to the high rate of recurrence of symptoms. Primar y
therapy is s urgical (Heller's modified esophagomyotomy), and results are similar after a transabdominal o r
thoracic .hcaorppa ynaM nac enipidefiN .stneitap eseht ni serudecorp xulferitna tnatimocnoc a rovaf srohtua
shhaomoea rabflstne p a gempeirnnet p aratifsoounrr gerLyo.n g-terrems uplrte secnotans n'e ction
esobptmaehhactaelhwg diaaeuoignlesfsndan. ea s anistae
seilamonA lanedoud-ortsaG .C
seilamonA cirtsaG .1
Congenital cir t nstoaeiglttcuuort ss biyoleme r.texrear tI sruc croehtie region.antral or pyloric the in
Antral membr anes (web or diaphragm) are thin, soft and pliable, composed of mucosa/submucosa, an d
located eccentric 1-3 cm proximal to pyloro-duodenal junction. They probably represent the developmenta l
aid ehT .ycnadnuder dna noitarefilorp lamredodne lacol ssecxe fo tcudorp tsartnoc ,yrotsih no yler dluohs sisong
era smotpmyS .sgnidnif cipocsodne dna seiduts ygolonegtneor yrav dna gnitimov suoilib-non tnerrucer fo esoht
according to the diameter of aperture of the membrane. There is a slight male predominance with fai r
ubirtsid .caidrac dna reclu citpep ,sisonets cirolyp :snoitidnoc detaicossA .nerdlihc ni spuorg ega neewteb noit
rdyhylop fo yrotsiH mottahDhmeeien mnriro .oan sds itaor laouptlfceii eronnpnetoe a l fnxodtinihsgce t u ol ar
fo citsongaid si murtna eht surgicaleither be can Management diagnosis. the corroboratesE ndoscopy web. a
amotpmys ni lufsseccus si xT lacigruS .lacigrus-non ro noisicxe ro noisicni htiw ytsalporolyp fo tsisnoc dna .tp cit
evitanretla rehtO .enarbmem eht fo Non-obstructiveweb. the of transection or dilatation balloon endoscopic is
c llams htiw yllacidem deganam eb nac yllatnedicni dnuof sbew ufrodr mualanand t ispasmodicTsph.re e sence
elbbub cirtsag detalid yllamronba na fo sisongaid eht drawot naicisyhp eht trela dluohs yhpargonos latanerp ni
acnotnorgboes-ntpirytulaocolftr iiocn .
sisonetS cirolyP .2
sI an abnormality of the pyloric earlyin obstruction outlet gastric causin(gh ypertrmoupshcyu)l ature
ni proteinformula to pylorospasm but unknown, is etiology The births. live 1000 per 3 is incidence The fancy.
ca esu a work hypertrophy of the muscle. Diagnostic characteristics are: non-bilious projectile vomitin g
classically 3- 6 weeks of age, palpable pyloric muscle "olive", contrast studies are not necessary when th e
ppauyllmlpitueolasrsinret acnlineaswl acgdnoier t,dnd gh ote ghdr aphy.
isolakla cimerolhcopyh fo noitcerroc ni tsisnoc tnemtaert ehT dehpyoedsfrrta faanoattdrnie mdo i nn sg
a Frede t-Ramstedt modified pyloromyotomy. Post-operative management consist of: 50% will have one t o
nitimov fo sedosipe lareves 2h4oi-uin3hrni6ofs hst ma8e,gotief-e ouuaa at1d fsrrlne2seust dcgr ea a,dln l y
.yregrus
D3u.o denMaall for mat io ns
ertA( cisnirtni eb naC latsid ruccO .)sdnab s'ddaL ,saercnap ralunnA( cisnirtxe ro )sbeW ,sisonetS ,ais
oc tsoM .retaV fo allupma eht ot lamixorp ro mamtmdohpiatneusnolrltd yelab falio lvripoeorm ueiissts ei nntg.
.)ybab a ni esiwrehto nevorp litnu lacigrus si gnitimov suoiliB :etoN(
"Windsoc k" webs have clinical importance because of their tendency to be confused with dista l
cnerrucco tneuqerf eht fo esuaceb dna noitcurtsbo lanedoud anoamna oblfio lueedis nua tcretyar tlihonengig r
mediamla rgin.
Embryol :ygo The first major event in the differentiation of the duodenum, hepatobiliary tree, an d
ni keew driht eht tuoba ta srucco saercnap junctionthe at form buds pancreatic and biliary the when gestation,
of the foregut and the midgut. The duodenum at this time is a solid cord of epithelium, which undergoe s
vacuolizati on followed by recanalization and restitution of the intestinal lumen over 3-4 weeks of norma l
development. Failure of recanalization of the second part dutohdeore cfeno suniumgnl e tnsoi btsatlr uction
atnempoleved htiw noitcnujnoc ni netfo ,nemul eht fo mla lformatiootnfh p ea ncreatiacn lageannt dht ee rminal
yrailib eht fo trap believedobserved, pancreas annular of incidence high the is concept this of support In tree.
.noitcurtsbo lanedoud cisnirtni htiw noitaicossa ni egalna citaercnap lartnev eht fo ecnetsisrep a tneserper ot
The citsongai dscitsiretcarahc :era suoilib ,gnitimov yrotsih fo soinmardyhylop ni ,rehtom BUKtiw h
classi"cD ouble-bubblea"p pearancmeai, c rocoloibnna riuemn emsat udomyra lrotation.
etneciV-oguL rD/koobdnaH gruSdeP - 01