Commonly Treated Ailments
Pediatric surgeons on staff at Abington Memorial Hospital provide surgical treatment for babies and children. These surgeons, led by Ala Sanford Frey, M.D., and our staff of specially trained nurses, are experts in caring for a variety of conditions and diseases.
The most frequent abnormality of the pancreas is annular pancreas in which a thin flat band of pancreatic tissue surrounds the first part of the small intestine (duodenum) and continues on either side into the head of the pancreas.
Acute appendicitis is one of the most common causes of abdominal pain in childhood. This diagnosis must be considered in all age groups but is more common between the ages of 4 and 15 years. The function of the appendix is unknown. However, in rabbits and other animals the cecum is similar in shape to the appendix and plays a role in digestion of food. The middle, inside portion of the appendix may be irregular and somewhat narrow because of the presence of lymph nodes in the wall of the appendix.
In normal infants bile drains from the liver to the duodenum (the first portion of the small intestine) through a series of ducts. Ducts are like pieces of hollow tubing. Thousands of very small ducts in the liver become two large ducts that join to form a single hepatic duct that drains into the intestine. The gallbladder is a reservoir for bile that empties into the hepatic duct halfway between the liver and the duodenum. After the gallbladder joins the main duct draining the liver, the duct is called the common bile duct. Biliary atresia is a disorder occurring in infants in which the bile ducts disappear or scar closed, preventing the passage of bile out of the liver.
A problem that occurs mostly in older children and adults is biliary dyskinesia. This happens when the gallbladder does not squeeze properly and the bile does not drain out of the gallbladder properly.
Brachial Cysts, Sinuses and Remnants
Branchial arches are structures that appear in the fourth week of development on either side of the head and neck. Paired outpouchings from the inner lining of the early part of the mouth and throat along with clefts (inward indentations) appear along with muscular, nervous structures, and connective tissue in the neck area. Continued development in this area, from the outpouchings and from the clefts results in the ear canal, tonsil, throat structures, parathyroid glands and thymus. There are four distinct clefts, each giving rise to abnormalities if incomplete development occurs or there is a failure of these primitive structures to go away.
Pediatric breast problems can be categorized to those that arise in infancy and those later in childhood. They may manifest as nipple discharge, masses or lumps, with redness or swelling of the breast area. It is not uncommon for some children to have extra breast tissue or extra nipple tissue. This extra tissue rarely causes any physical symptoms but can be removed if it leads to emotional or psychological problems.
BROVIAC Catheters, PICC Lines and Other Catheters
Cervical Cysts, Sinuses, and other Neck Lesions
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.
Chest (Mediastinal) Cysts
Mediastinal cysts and tumors are relatively common in infants and children. Although cysts of the mediastinum are often asymptomatic, they usually require removal. If cysts are symptomatic, they may present with chest pain, cough, breathing problems, bloody cough or bloody vomiting, and difficulty swallowing. The various cysts encountered include bronchogenic cysts, thymic cysts, enterogenous cysts, neurenteric cysts, dermoid cysts, cystic hygroma, and pericardial cysts.
Cholecystitis Acalculous - (Gallblader inflammation without gallstones)
Acalculous cholecystitis may occur as a complication during treatment of various diseases. This condition may occur in newborns but is more common in older children. Boys and girls are affected equally. Patients are often severely ill as a result of prior surgery; a severe burn; extensive trauma; massive blood transfusion; and various infections, including pneumonia, a generalized infection (sepsis), typhoid, salmonella, otitis media with meningitis, giardiasis, and Kawasaki disease. The cause is unknown, but may be in part due to dehydration, ileus (a condition where the bowel does not squeeze properly), gallbladder stasis (bile not being squeezed out of the gallbladder), treatment with total parenteral nutrition (TPN), and breakdown of blood from multiple transfusions.
Gallstones are relatively uncommon in blacks (except in sickle cell disease), exceptionally common in groups of Native Americans and Hispanics, and a frequent occurrence in whites. Gallstones currently are being recognized in children with increased frequency. Whether this increase in diagnosis is related to an increase in frequency of the disease or an increase in recognition because of the widespread use of ultrasound for abdominal complaints is unclear. The incidence currently is reported to be 0.15% to 0.22% in children. In comparison, gallstones are found in approximately 10% of adults.
Crohn's disease (CD), also known as regional enteritis, is a type of inflammatory bowel disease (IBD) described by Crohn in 1932. The most common affected site of bowel inflammation is the distal part of the small intestine known as the ileum, although the colon and other segments of the intestinal tract can be involved as well. The other common type of IBD is termed ulcerative colitis, although this disease is limited to the colon (large intestine).
Empyema is a chest infection. Unlike pneumonia, which is an infection in the lung, empyema occurs in the space between the lung and the chest wall known as the pleural space (or pleural cavity). In children, empyema is usually a complication of pneumonia. Inflammatory reaction to the pneumonia produces fluid in the pleural space ("effusion"). If the infection from the pneumonia spreads to this fluid, pus may accumulate, resulting in empyema.
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.
Descriptions of children with Hirschsprung's Disease date back to the 17th century, when Ruysch (1691), a Dutch anatomist, described a five-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 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.
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 five and seven weeks after conception.
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.
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.
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.
Perianal and Perirectal Abscess
Perianal abscesses (pus collection) and fistulas (tunnels that connect the inside of the anus to the skin outside) are seen commonly in male infants younger than one year of age with a peak incidence at four months of age.
Pyloric stenosis is the most common disorder causing vomiting in infancy which requires surgery.
Solid Chest (Medistinal) Tumors
Mediastinal tumors are fairly common in children and can be either benign (noncancerous) or cancerous (malignant). Approximately 60% are malignant. These tumors include Hodgkin's disease, non-Hodgkin's lymphoma, neurogenic tumors, thymomas, teratomas, lipomas, lipoblastoma, germ cell tumors, and other rare lesions.
The spleen was long believed to be an unnecessary organ that could be removed without causing any problems. Important functions of the spleen have now been discovered, however, including the removal of bacteria and waste from the blood, the making of antibodies, and the making of red blood cells.
Thyroglossal Duct Cysts and Sinuses
Embryology: The thyroid gland, although situated in the lower portion of the neck around the trachea, originates in the mouth at the back of the tongue and then moves down the neck during development. As the thyroid gland moves down to its normal position, there is a connection to the base of the tongue that should disappear by the time the thyroid reaches its final position. If it does not, there may be a persistent hollow tube that may allow accumulation of mucoid material and the formation of a cyst at the end.
A thyroid nodule is a lump found in the gland. They can be malignant (cancer) or benign (not cancer). Although thyroid nodules are more common in adults than children, they are more likely (20-30%) to be malignant in children.
Torsion of Testicular Appendix
Torsion of an appendix testis and appendix epididymis are common causes of torsion. Both of these are small tags of normal tissue attached to the testicle.
Ulcerative colitis (UC) was described almost 150 years ago. Despite significant advancements in the knowledge of inflammatory bowel disease (IBD), this disorder's cause and treatment remain unresolved. Although classically thought of as a disorder of adults, many children are affected. The pediatric surgeon is often instrumental in caring for patients with this disabling disease.
Umbilical (belly button) Hernia
After birth, when the end of the umbilical cord, along with the umbilical vein, umbilical arteries, and urachal remnant, dry up, a small opening is left in the abdominal wall. Failure of the muscles to close around this opening causes an umbilical hernia.
After normal separation of the umbilical cord; pink, healing tissue called granulation tissue may persist in the belly button and enlarge into a mass called an umbilical granuloma . This is often associated with umbilical drainage and swelling with redness of the surrounding skin.
An empty scrotum is found in 20% to 30% of premature infants and 1.2% to 4% of mature newborns. This means that there is no testicular tissue that can be found in the scrotum. The diagnosis of true undescended testis may be difficult to determine before age six months, particularly in premature infants.
The urachus is a fetal structure that extends up from the top of the bladder to the lower part of the umbilicus (belly button). While it may remain open throughout life, the urachus usually collapses and becomes occluded after birth. The urachus may produce symptoms if some or all of it remains open after birth.