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Symptoms and Signs in Pediatric Surgery
Kaiser
Editore
Springer
Anno
2012
Pagine
620
ISBN
9783642311611
130,00 €
I prezzi indicati possono subire variazioni poiché soggetti all'oscillazione dei cambi delle valute e/o agli aggiornamenti effettuati dagli Editori.
  • Concise textbook that guides the reader from presenting symptoms and signs to diagnosis and treatment
  •  
  • Covers 35 key symptoms and signs organized according to body region
  •  
  • Designed to be of value to all physicians and surgeons who care for children, whether specialists or generalists

This concise textbook of pediatric surgery is designed to guide the reader logically from symptoms and signs to diagnosis and treatment. Each chapter is devoted to one of 35 key symptoms and signs, which are organized according to six body regions: head, neck, chest, abdomen, urogenital system, and back. In each case, a brief assessment of the presenting sign/symptom and differential diagnosis is followed by discussion of occurrence, clinical presentation and significance, diagnostic work-up, treatment, and prognosis. Informative tables, illustrations, and up-to-date references are included throughout. Readers will also have access to an e-learning tool developed in collaboration with the Institute of Medical Education, University of Bern, which highlights the characteristics of pediatric surgical disorders and their treatment and includes clinical, radiological, and intraoperative images.

 

Every physician and surgeon, whether specialist or generalist, who cares for children will find this book to be an invaluable source of information. It is based on the extensive personal experience of the author, which includes teaching at all levels and training of pediatric surgeons.

xi
Contents
Part I Head
1 Tumors, Tumor-Like Masses, and Abnormalities
of Scalp, Calvaria, and Adjacent Regions ................................. 3
1.1 Congenital Pathologies ........................................................ 4
1.1.1 Dermoid and Epidermoid Cysts .............................. 4
1.1.2 Special Forms of Dermoid and Epidermoid Cysts
(Midline Forms) ....................................................... 6
1.1.3 Vascular Malformations ........................................... 7
1.1.4 Atretic Cephalocele (Abortive Encephalocele) ....... 8
1.1.5 Cephalocele (Encephalocele) .................................. 8
1.1.6 Nasal Glioma (Glial Heterotopia of the Nose) ........ 10
1.1.7 Sinus Pericranii ........................................................ 11
1.1.8 Congenital Scalp (Aplasia Cutis Congenita)
and Skull Defects ..................................................... 11
1.2 Traumatic Pathologies ......................................................... 12
1.2.1 Cephalhematoma ..................................................... 12
1.2.2 Growing or Enlarging Skull Fracture
(Leptomeningeal Cyst) ............................................ 13
1.2.3 Subperiosteal and Subgaleal
(Subaponeurotic Cephalhematoma) Hematoma ...... 14
1.3 Inflammatory Pathologies ................................................... 15
1.3.1 Infections of the Galea and Osteomyelitis
of the Skull ............................................................... 15
1.4 Neoplastic Pathologies ........................................................ 16
1.4.1 Hemangioma ............................................................ 16
1.4.2 Rare Tumors and Tumor-Like Masses
of the Soft Tissue (Galea) ........................................ 17
1.4.3 Osteoma ................................................................... 18
1.4.4 Fibrous Dysplasia .................................................... 18
1.4.5 Eosinophilic Granuloma (Histiocytosis X) ............. 20
1.4.6 Rare Benign and Malignant Skull Tumors .............. 21
Webcodes ....................................................................................... 22
Bibliography .................................................................................. 23
xii Contents
2 Macrocrania ................................................................................. 27
2.1 Hydrocephalus..................................................................... 27
2.2 Constitutional Macrocrania
(Benign Familial Macrocephaly) ........................................ 35
2.3 Intraventricular (Periventricular/Intraventricular)
Hemorrhage of the Newborn (in Prematurity) .................... 36
2.4 Catch-Up Growth of Head Circumference.......................... 37
2.5 Congenital Intracranial Cysts .............................................. 38
2.6 Subacute and Chronic Subdural Hematoma (Hygroma) ..... 41
2.7 Encephalopathies, Metabolic Disorders
with Brain Involvement ....................................................... 43
2.8 Achondroplasia (Chondrodysplasia) ................................... 44
Webcodes ....................................................................................... 45
Bibliography .................................................................................. 45
3 Unconsciousness and Altered States of Consciousness ............. 49
3.1 Head Injury.......................................................................... 50
3.1.1 Cerebral Concussion ................................................ 51
3.1.2 Syndrome of Cerebral Concussion
in Children (Delayed Encephalopathy) ................... 53
3.1.3 Skull Fractures ......................................................... 54
3.1.4 Cerebral Contusion .................................................. 56
3.1.5 Epidural Hematoma ................................................. 58
3.1.6 Subdural and Intracerebral Hematoma .................... 59
3.1.7 Child Abuse, Battered Child Syndrome (BC) ......... 60
3.2 Convulsive Attacks and Epilepsy ........................................ 62
3.3 Fat Embolism Syndrome, Fat Embolism ............................ 63
3.4 Shunt Dysfunction, Decompensation
of Native Hydrocephalus ..................................................... 63
3.5 Disorders with Septicemia or Blood Volume Deficit .......... 64
3.6 Spontaneous Intracranial Hemorrhage ................................ 65
3.7 Pediatric Disorders .............................................................. 66
3.8 Conversion Disorders .......................................................... 66
Webcodes ....................................................................................... 67
Bibliography .................................................................................. 67
4 Conspicuous and/or Abnormal Head Shape ............................. 69
4.1 Single Suture Synostosis ..................................................... 70
4.1.1 Sagittal Synostosis ................................................... 70
4.1.2 Coronal Synostoses (Bi- and Unilateral) ................. 74
4.1.3 Metopic Synostosis
(Trigonocephaly, Frontal Synostosis) ...................... 76
4.1.4 Lambdoid Synostosis (Bi- and Unilateral) .............. 77
4.2 Multiple-Suture Synostosis (Pansynostosis) ....................... 78
4.3 Syndromic Craniosynostosis (Craniofacial Dysostosis) ..... 80
4.4 Treatment ............................................................................ 82
4.4.1 Indication ................................................................. 82
4.4.2 Risks ........................................................................ 82
4.4.3 Surgery ..................................................................... 83
Contents xiii
4.5 Prognosis ............................................................................. 84
Webcodes ....................................................................................... 85
Bibliography .................................................................................. 85
5 Malformations of the Face Visible from the Outside ................ 89
5.1 Orofacial Clefts ................................................................... 89
5.1.1 Cleft Lip (Alveolus) Palate ...................................... 89
5.1.2 Other Orofacial Clefts ............................................. 92
5.2 Nasal Clefts ......................................................................... 95
5.2.1 Median and Lateral Nasal Clefts ............................. 95
5.3 Congenital Fistulas of the Face ........................................... 96
5.3.1 Congenital Lip Fistulas ............................................ 96
5.3.2 Congenital Fistulas of the Nose and Auricle ........... 96
Webcodes ....................................................................................... 96
Bibliography .................................................................................. 96
Part II Neck
6 Torticollis ...................................................................................... 101
6.1 Congenital Forms of Torticollis .......................................... 102
6.1.1 Congenital Muscular Torticollis .............................. 102
6.1.2 Postural Torticollis ................................................... 105
6.1.3 Klippel-Feil Syndrome ............................................ 105
6.1.4 Other Malformations of the Cervical Spine ............ 106
6.2 Acquired Forms of Torticollis ............................................. 107
6.2.1 Acute Nontraumatic Torticollis (Wryneck) ............. 107
6.2.2 Traumatic Torticollis
(Cervical Spine Injuries) .......................................... 108
6.2.3 Grisel Syndrome ...................................................... 109
6.2.4 Atlantoaxial Rotatory Subluxation or Fixation ....... 110
6.2.5 Sandifer Syndrome .................................................. 111
6.2.6 Ocular Torticollis ..................................................... 112
6.2.7 Torticollis in Pneumomediastinum
and Other Disorders ................................................. 112
6.2.8 Neurogenic Torticollis ............................................. 113
6.2.9 Medicamentous Torticollis ...................................... 114
6.2.10 Psychogenic Torticollis ............................................ 114
Webcodes ....................................................................................... 114
Bibliography .................................................................................. 114
7 Tumors and Tumor-Like Masses and Fistulas of the Neck ...... 117
7.1 Congenital Midline Pathologies ......................................... 117
7.1.1 Thyroglossal Duct Cyst ........................................... 117
7.1.2 Dermoid and Epidermoid Cyst ................................ 119
7.1.3 Congenital Midline Cervical Cleft .......................... 120
7.1.4 Ectopic Thyroid or Thymic Tissue .......................... 120
7.1.5 Cervical Teratoma .................................................... 121
7.1.6 Congenital Obstructive Goiter ................................. 121
xiv Contents
7.2 Acquired Midline Pathologies ............................................ 122
7.2.1 Thyroid Pathologies ................................................. 122
7.2.2 Primary Hyperparathyroidism ................................. 125
7.3 Congenital Lateral Pathologies .......................................... 126
7.3.1 Second Branchial Anomalies .................................. 126
7.3.2 First, Third, and Fourth Branchial Anomalies......... 128
7.3.3 Congenital Preauricular and Neck Tags .................. 129
7.3.4 Cystic Lymphangioma ............................................. 129
7.3.5 Preauricular Fistulas ................................................ 131
7.3.6 Congenital Disorders of the Salivary Glands .......... 132
7.4 Acquired Lateral Pathologies .............................................. 134
7.4.1 Lymphadenopathies ................................................. 134
7.4.2 Acute Lymphadenitis ............................................... 135
7.4.3 Subacute and Chronic Lymphadenitis ..................... 135
7.4.4 Primary Neoplastic Tumors and Metastases ........... 136
7.4.5 Acquired Pathologies of the Salivary Glands .......... 137
Webcodes ....................................................................................... 139
Bibliography .................................................................................. 139
Part III Chest
8 Mediastinal Tumors ..................................................................... 145
8.1 Anterior and Superior Mediastinum.................................... 147
8.1.1 Malignant Lymphomas ............................................ 147
8.1.2 Mesenchymal Tumors ............................................. 148
8.1.3 Germ Cell Tumors (Dermoid Cyst, Teratoma,
and Other Germ Cell Tumors) ................................. 149
8.1.4 Thymic Pathologies ................................................. 150
8.2 Middle Mediastinum ........................................................... 152
8.2.1 Inflammatory and Neoplastic Adenopathy .............. 152
8.2.2 Bronchogenic Cyst .................................................. 152
8.2.3 Pericardial Cyst ........................................................ 153
8.3 Posterior Mediastinum ........................................................ 153
8.3.1 Neuroblastoma ......................................................... 154
8.3.2 Ganglioneuroma and Ganglioneuroblastoma .......... 154
8.3.3 Neurogenic Tumors
(Cranial and Peripheral Nerves) .............................. 155
8.3.4 Enteric and Neurenteric Cysts
(Esophageal Duplication) ........................................ 155
Webcodes ....................................................................................... 157
Bibliography .................................................................................. 157
9 Respiratory Distress Syndrome of the Newborn
and Young Infant.......................................................................... 161
9.1 Obstruction of the Airways by Disorders
of Head and Neck or Larynx and Tracheobronchial Tree ... 162
9.1.1 Choanal Atresia ....................................................... 162
9.1.2 Congenital Tumors of Face, Nasal
or Oral Cavity and Pharynx, or Orbit ...................... 163
Contents xv
9.1.3 Macroglossia ............................................................ 164
9.1.4 Pierre Robin Sequence (Triad of Pierre Robin) ...... 165
9.1.5 Posterior Laryngeal
and Laryngotracheoesophageal Cleft ...................... 167
9.1.6 Laryngeal Disorders, Tracheal
Atresia and Stenosis ................................................. 168
9.2 Obstruction of the Airways by Disorders
with Valve Mechanism ........................................................ 170
9.2.1 Tracheobronchomalacia (Airway Malacia) ............. 170
9.2.2 Lobar Emphysema ................................................... 171
9.2.3 Congenital Cystic Lung Disorders,
Cystic Adenomatoid Malformation ......................... 172
9.3 Obstruction of Respiration by Intrathoracic
Lung Displacement ............................................................. 174
9.3.1 Congenital Diaphragmatic Hernia ........................... 174
9.3.2 Diaphragmatic Hernia of Morgagni ........................ 177
9.3.3 Diaphragmatic Eventration ...................................... 178
9.3.4 Chylothorax ............................................................. 179
9.3.5 Mediastinal Tumor ................................................... 180
9.3.6 Surgical Abdomen ................................................... 180
9.4 Obstruction of Respiration by Decreased
Pulmonary Reserve (Parenchymal Deficit) ......................... 180
9.4.1 Pulmonary Hypoplasia ............................................ 180
9.4.2 Lung Aplasia and Agenesis,
Post-Pneumonectomy Lung ..................................... 181
9.4.3 Anomalies of the Thoracic Cage ............................. 181
9.5 Obstruction of Respiration by Airway Aspiration .............. 181
9.5.1 Esophageal Atresia and Gastroesophageal Reflux .. 182
Webcodes ....................................................................................... 182
Bibliography .................................................................................. 182
10 Symptoms and Signs of Respiratory Organs
in Infants and Older Children .................................................... 189
10.1 Malformations and Acquired Disorders with Similar
Presentation in the Newborn or Later in Childhood ........... 189
10.2 Malformations and Acquired Disorders with Clinical
Manifestation After the Neonatal Period ............................ 189
10.2.1 Pulmonary Sequestration ......................................... 189
10.2.2 Bronchiectasis .......................................................... 192
10.2.3 Spontaneous Pneumothorax .................................... 193
10.3 Thoracic Injuries ................................................................. 194
10.3.1 General Remarks ..................................................... 194
10.3.2 Lung Contusion and Hematoma .............................. 197
10.3.3 Pneumothorax .......................................................... 197
10.3.4 Hemothorax ............................................................. 198
10.3.5 Rib Fractures ............................................................ 199
10.3.6 Lung Laceration and/or Injuries
to the Tracheobronchial Tree ................................... 200
xvi Contents
10.4 Cardiovascular Injuries ....................................................... 201
10.4.1 Cardiac Injuries ........................................................ 201
10.4.2 Rupture of the Aorta and Its Branches .................... 202
10.5 Foreign Body Aspiration ..................................................... 203
10.6 Complications of Inflammatory Disorders of the Lung ...... 204
10.6.1 Pleural Empyema ..................................................... 205
10.6.2 Lung Abscess ........................................................... 207
10.6.3 Pneumatocele ........................................................... 208
10.7 Lung Parasitosis .................................................................. 209
10.7.1 Pulmonary Cystic Echinococcosis
(Pulmonary Hydatid Cyst) ....................................... 209
10.8 Lung and Pleural Tumors .................................................... 210
10.8.1 Lung Tumors............................................................ 210
10.8.2 Pleural Tumors ......................................................... 212
Webcodes ....................................................................................... 212
Bibliography .................................................................................. 213
11 Chest Wall Deformities ................................................................ 219
11.1 Funnel Chest........................................................................ 219
11.1.1 Occurrence, Pathology, Associated Anomalies ....... 219
11.1.2 Clinical Significance ................................................ 219
11.1.3 Natural History, Clinical Presentation ..................... 219
11.1.4 Work-Ups, Differential Diagnosis ........................... 221
11.1.5 Treatment, Prognosis ............................................... 221
11.1.6 Prognosis.................................................................. 222
11.2 Pectus Carinatum (Protrusion Deformity
of the Chest, Pigeon Breast) ................................................ 223
11.2.1 Occurrence, Surgical Pathology .............................. 223
11.2.2 Clinical Significance ................................................ 223
11.2.3 Clinical Presentation ................................................ 223
11.2.4 Work-Ups, Differential Diagnosis ........................... 224
11.2.5 Treatment, Prognosis ............................................... 224
11.3 Poland’s Syndrome.............................................................. 224
11.3.1 Occurrence, Pathology ............................................. 224
11.3.2 Clinical Significance ................................................ 225
11.3.3 Clinical Presentation ................................................ 225
11.3.4 Work-Ups, Differential Diagnosis ........................... 225
11.3.5 Treatment, Prognosis ............................................... 225
11.3.6 Prognosis.................................................................. 226
11.4 Sternal Defects .................................................................... 226
11.4.1 Cleft Sternum ........................................................... 226
11.4.2 Ectopia Cordis ......................................................... 226
Webcodes ....................................................................................... 227
Bibliography .................................................................................. 227
12 Tumors, Tumor-Like Masses, Nipple Discharge,
and Anomalies of the Breast ....................................................... 229
12.1 Congenital Pathologies ........................................................ 229
12.1.1 Hypoplasia and Aplasia of Breast and/or of
Nipple (Micromastia, Amastia, and/or Athelia) ...... 229
Contents xvii
12.1.2 Diffuse Enlargement of the Breast in the
Newborn .................................................................. 230
12.1.3 Inversion, Hypertrophy, and Multiplication
of the Nipple(s) ........................................................ 231
12.2 Acquired Pathologies .......................................................... 231
12.2.1 Acquired and Secondary Hypoplasia
and Aplasia of the Breast ......................................... 231
12.2.2 Nipple Discharge ..................................................... 231
12.2.3 Mastitis .................................................................... 232
12.2.4 Diffuse Enlargement of the Breast .......................... 233
12.2.5 Localized Masses of the Breast ............................... 234
Webcodes ....................................................................................... 236
Bibliography .................................................................................. 236
13 Malformations, Neoplasms, and Other Disorders
of the Chest Wall .......................................................................... 239
13.1 Congenital Pathologies ........................................................ 239
13.1.1 Polythelia, Polymastia ............................................. 239
13.1.2 Circumscribed Anomalies of the Ribs ..................... 240
13.2 Acquired Pathologies: Soft Tissue Tumors
and Tumor-Like Masses ...................................................... 240
13.2.1 Pilomatricoma (Pilomatrixoma,
Calcifying Epithelioma of Malherbe) ...................... 240
13.2.2 Fibromatosis ............................................................ 241
13.2.3 Hemangiomas, Lymphangiomas,
Vascular Malformations, and Lipomas .................... 242
13.2.4 Melanotic Nevi ........................................................ 242
13.3 Acquired Pathologies: Tumors and Tumor-Like Masses
of the Chest Wall and Ribs .................................................. 244
13.4 Acquired Pathologies of the Chest Wall: Inflammatory
Disorders ............................................................................. 246
Webcodes ....................................................................................... 246
Bibliography .................................................................................. 246
Part IV Abdomen
14 Surgical Abdomen ........................................................................ 253
14.1 Surgical Abdomen, General Remarks ................................. 253
14.2 Surgical Abdomen, Disorders with Peritonitis .................... 254
14.2.1 Acute Appendicitis .................................................. 254
14.2.2 Meckel’s Diverticulitis ............................................. 258
14.2.3 Cholelithiasis, Cholecystitis .................................... 258
14.2.4 Acute Pancreatitis .................................................... 261
14.2.5 Chronic Pancreatitis
(Chronic Relapsing Pancreatitis) ............................. 262
14.2.6 Primary (Spontaneous) Peritonitis ........................... 263
14.2.7 Omental Infarction ................................................... 265
Webcodes ....................................................................................... 265
Bibliography .................................................................................. 265
xviii Contents
15 Surgical Abdomen due to Intestinal Obstructions .................... 269
15.1 Surgical Abdomen of the Newborn ..................................... 269
15.1.1 Obstructive Ileus of the Newborn,
General Remarks ..................................................... 269
15.1.2 Intrinsic and Extrinsic Duodenal Obstruction ......... 270
15.1.3 Jejunal and Ileal Atresia and Stenosis ..................... 272
15.1.4 Meconium Ileus ....................................................... 275
15.1.5 Meconium Peritonitis .............................................. 276
15.1.6 Intestinal Duplications ............................................. 277
15.1.7 Disorders of Intestinal Rotation
and Fixation (Malrotation of Intestine) ................... 278
15.1.8 Anorectal Malformations ......................................... 283
15.1.9 Spontaneous Perforation
of the Gastrointestinal Tract .................................... 286
15.2 Surgical Abdomen due to Intestinal Obstruction
of Infancy and Thereafter .................................................... 287
15.2.1 Acute Intussusception (Invagination) ...................... 287
15.2.2 Postoperative Ileus due to Adhesions ...................... 290
15.2.3 Rare Abdominal Wall, Pelvic Floor,
and Internal Hernias ................................................. 292
15.2.4 Sickle Cell Disease .................................................. 293
Webcodes ....................................................................................... 294
Bibliography .................................................................................. 294
16 Surgical Abdomen due to Abdominal Trauma
and Foreign Bodies ....................................................................... 299
16.1 Abdominal Trauma ............................................................. 299
16.1.1 General Features of Abdominal Trauma ................. 299
16.1.2 Injury of the Kidney................................................. 301
16.1.3 Injury of the Spleen ................................................. 303
16.1.4 Injury of the Liver .................................................... 304
16.1.5 Injuries of Pancreas and Duodenum ........................ 306
16.1.6 Perforations of the Gastrointestinal Tract ................ 308
16.1.7 Injuries to the Diaphragm or Pelvis ......................... 309
16.2 Foreign Bodies of the Gastrointestinal Tract ...................... 310
Webcodes ....................................................................................... 311
Bibliography .................................................................................. 311
17 Chronic Abdominal Pain ............................................................. 313
Webcodes ....................................................................................... 314
Bibliography .................................................................................. 314
18 Disorders of the Abdominal Wall Recognizable
from the Outside (Excluding Abdominal Wall Hernias) .......... 315
18.1 Pathologies of the Navel (Excluding Umbilical Hernia)..... 315
18.1.1 Umbilical Granuloma, Omphalitis .......................... 315
18.1.2 Remnants of the Omphalomesenteric
(Vitellointestinal) Duct ............................................ 316
18.1.3 Urachal Remnants .................................................... 317
Contents xix
18.1.4 Miscellaneous Congenital
and Acquired Disorders of the Navel ...................... 318
18.2 Omphalocele and Gastroschisis (Common Topics I) .......... 318
18.2.1 Omphalocele ............................................................ 320
18.2.2 Gastroschisis ............................................................ 320
18.3 Omphalocele and Gastroschisis (Common Topics II)......... 320
18.4 Bladder Exstrophy ............................................................... 323
18.5 Cloacal Exstrophy (Vesicointestinal Fissure) ...................... 325
Webcodes ....................................................................................... 326
Bibliography .................................................................................. 326
19 Swelling of the Groin and Navel ................................................. 329
19.1 Swelling and Pain of the Groin Including Scrotum ............ 329
19.1.1 Inguinal Hernia ........................................................ 329
19.1.2 Hydrocele of the Cord or Canal of Nuck (Girls) ..... 333
19.1.3 Cryptorchidism Including Torsion
of Undescended Testis ............................................. 334
19.1.4 Inguinal Lymphadenopathy ..................................... 334
19.1.5 Pain in the Groin ...................................................... 335
19.2 Swelling and Pain of the Navel and Linea Alba ................. 335
19.2.1 Umbilical Hernia ..................................................... 335
19.2.2 Epigastric Hernia ..................................................... 336
Webcodes ....................................................................................... 337
Bibliography .................................................................................. 337
20 Vomiting, Regurgitation, and Dysphagia ................................... 339
20.1 Esophageal Atresia, Isolated Tracheoesophageal Fistula ... 339
20.2 Gastroesophageal Reflux, Hiatus Hernia ............................ 342
20.3 Hypertrophic Pyloric Stenosis............................................. 345
20.4 Gastric Emptying Disorders ................................................ 347
20.5 Esophageal Stenosis ............................................................ 348
20.5.1 Congenital Esophageal Stenosis .............................. 348
20.5.2 Acquired Esophageal Stenosis ................................ 349
20.6 Achalasia ............................................................................. 349
20.7 Functional Disorders of Swallowing ................................... 350
20.8 Gastric Volvulus, Paraesophageal Hernia,
and Upside-Down Stomach ................................................. 350
20.9 Foreign Body Ingestion ....................................................... 351
20.10 Corrosive Ingestion (Caustic Stricture
of the Upper Gastrointestinal Tract) .................................... 353
Webcodes ....................................................................................... 355
Bibliography .................................................................................. 355
21 Constipation.................................................................................. 359
21.1 Disorders of Intestinal Innervation ...................................... 360
21.1.1 Hirschsprung’s Disease (Congenital Megacolon) ... 360
21.1.2 Intestinal Neuronal Dysplasia (IND) ....................... 365
21.1.3 Immaturity of the Enteric Nervous System
(Plexus Immaturity) ................................................. 366
21.1.4 Anal Sphincter Achalasia ........................................ 367
xx Contents
21.2 Anal and Rectal Stenosis ..................................................... 367
21.3 Anterior Ectopic (Perineal) Anus ........................................ 368
21.4 Postoperative Anorectal Anomalies,
Hirschsprung’s Disease, and Spina Bi fi da .......................... 369
21.5 Meconium Plug Syndrome, Small Left Colon Syndrome .. 369
21.6 Chronic Idiopathic Intestinal Pseudoobstruction ................ 370
Webcodes ....................................................................................... 371
Bibliography .................................................................................. 372
22 Hematemesis ................................................................................. 375
22.1 Swallowed Blood ................................................................ 375
22.2 Gastroesophageal Reflux ..................................................... 376
22.3 Peptic Ulcer Disease (Gastric and Duodenal Ulcer) ........... 377
22.4 Esophageal and Gastric Varices .......................................... 379
Webcodes ....................................................................................... 382
Bibliography .................................................................................. 382
23 Lower Gastrointestinal Bleeding (Melena) ................................ 385
23.1 Disorders with Upper Gastrointestinal Bleeding ................ 385
23.2 Disorders with Lower Gastrointestinal Bleeding ................ 385
23.2.1 Intestinal Volvulus ................................................. 385
23.2.2 Acute and Chronic Intussusception ....................... 387
23.2.3 Henoch-Schönlein Purpura
(Palpable Purpura with Normal Thrombocytes).... 388
23.2.4 Meckel’s Diverticulum .......................................... 389
23.2.5 Intestinal Duplication ............................................ 390
23.2.6 Necrotizing Enterocolitis (NEC) ........................... 390
23.2.7 Polyps of the Gastrointestinal Tract ...................... 393
23.2.8 Incarcerated and Strangulated Inguinal Hernia ..... 395
23.2.9 Hemorrhoids .......................................................... 395
23.2.10 Anal Fissure ........................................................... 396
23.2.11 Perineal (Perianal) Injury....................................... 397
23.3 Inflammatory Bowel Diseases (IBD) .................................. 399
23.3.1 Crohn’s Disease ..................................................... 399
23.3.2 Ulcerative Colitis ................................................... 400
23.4 Other Frequent and Rare Causes
of Lower Gastrointestinal Bleeding .................................... 402
Webcodes ....................................................................................... 402
Bibliography .................................................................................. 403
24 Abdominal Tumor ........................................................................ 407
24.1 Neoplastic Masses and Cysts .............................................. 407
24.1.1 Nephroblastoma (Wilms’ Tumor) ......................... 407
24.1.2 Neuroblastoma ....................................................... 411
24.1.3 Rhabdomyosarcoma .............................................. 413
24.1.4 Teratoma and Other Germ Cell Tumors ................ 415
24.1.5 Non-Hodgkin’s Lymphoma
and Hodgkin’s Lymphoma .................................... 416
24.1.6 Tumors and Cysts of the Ovary ............................... 417
Contents xxi
24.1.7 Liver Tumors ........................................................... 420
24.1.8 Pancreatic and Adrenal Gland Tumors .................... 421
24.1.9 Rare Tumors ............................................................ 425
24.2 Masses or Cysts Caused by Anomalies, Inflammations,
and Injuries .......................................................................... 425
24.2.1 Mesenteric and Omental Cysts ................................ 425
24.2.2 Other Malformative Abdominal
Masses and Cysts ..................................................... 426
24.2.3 Abdominal Masses and Cysts Related
to Inflammation ........................................................ 426
24.2.4 Abdominal Masses and Cysts Related
to Trauma and Other Causes.................................... 426
24.3 Abdominal Masses and Cysts due to Parasitoses ................ 426
24.3.1 Echinococcosis (Hydatid Disease) .......................... 426
24.4 Abdominal Tumors Related to Other Causes ...................... 427
24.4.1 Ascites...................................................................... 427
24.4.2 Other Causes Simulating Abdominal Tumor .......... 429
Webcodes ....................................................................................... 429
Bibliography .................................................................................. 429
25 Jaundice (Icterus) ......................................................................... 433
25.1 Biliary Atresia ..................................................................... 434
25.2 Choledochal Cyst ................................................................ 436
25.3 Interlobular Biliary Hypoplasia ........................................... 439
25.4 Inspissated Bile Syndrome .................................................. 440
25.5 Cholelithiasis, Cholecystitis ................................................ 440
25.6 Spontaneous Perforation of the Extrahepatic
Biliary System ..................................................................... 440
Webcodes ....................................................................................... 441
Bibliography .................................................................................. 441
Part V Urogenital System
26 Hematuria ..................................................................................... 445
26.1 Urinary Tract Malformations .............................................. 446
26.1.1 Pelvicureteral Junction Anomalies (Obstruction) ... 446
26.1.2 Retrocaval Ureter ..................................................... 448
26.2 Tumors ................................................................................ 449
26.2.1 Polyps of the Urinary Tract ..................................... 449
26.3 Traumatic Injuries ............................................................... 449
26.3.1 Bladder, Urethral, and Ureteral Injuries .................. 449
26.3.2 Other Forms of Injuries to Kidney,
Urinary Tract, and External Genitals ....................... 451
26.3.3 Peri-interventional and Perioperative Hemorrhage . 452
26.3.4 Manipulation of the Penis ........................................ 452
26.4 Urolithiasis and Foreign Bodies of the Urinary Tract ......... 453
26.4.1 Urinary Lithiasis ...................................................... 453
26.4.2 Foreign Bodies of Bladder and Urethra ................... 455
26.5 Urinary Tract Infection ........................................................ 455
xxii Contents
26.5.1 Bilharzial Cystitis and Urogenital Schistosomiasis . 455
26.6 Pediatric Nephrological Disorders ...................................... 456
Webcodes ....................................................................................... 456
Bibliography .................................................................................. 457
27 Urinary Tract Infection ............................................................... 459
27.1 Obstructive Uropathies of the Upper Urinary Tract ............ 460
27.1.1 Obstructive Megaureter ......................................... 461
27.1.2 Prune-Belly Syndrome
(Eagle-Barrett or Triad Syndrome) ........................ 463
27.1.3 Ureteroceles ........................................................... 465
27.2 Ureteral Duplications .......................................................... 467
27.2.1 Complete Ureteral Duplication .............................. 467
27.2.2 Incomplete Ureteral Duplication ........................... 469
27.3 Fusion Anomalies of the Kidney ......................................... 470
27.3.1 Horseshoe Kidney .................................................. 470
27.3.2 Crossed Renal Ectopia ........................................... 471
27.4 Renal Ectopia ...................................................................... 471
27.5 Renal Aplasia, Hypoplasia, and Dysplasia ......................... 472
27.5.1 Renal Aplasia ......................................................... 473
27.5.2 Renal Hypoplasia or Dysplasia ............................. 473
27.6 Cystic Disorders of the Kidney ........................................... 474
27.6.1 Multicystic Renal Dysplasia .................................. 474
27.6.2 Autosomal Recessive Polycystic Kidney
Disease (ARPKD).................................................. 475
27.6.3 Autosomal Dominant Polycystic Kidney Disease
(ADPKD) ............................................................... 475
27.6.4 Localized Formation of Cysts................................ 476
27.7 Vesicoureteral Reflux (VUR, Reflux) ................................. 477
27.8 Bladder Diverticulum .......................................................... 481
27.9 Cystitis................................................................................. 482
27.9.1 Granular Cystitis .................................................... 482
27.10 Dysfunctional Voiding, Neurogenic Bladder, and
Obstructive Uropathies of the Lower Urinary Tract ........... 483
27.10.1 Phimosis ................................................................. 483
Webcodes ....................................................................................... 484
Bibliography .................................................................................. 485
28 Disorders of Micturition .............................................................. 489
28.1 Obstructive Uropathies of the Lower Urinary Tract ........... 490
28.1.1 Bladder Neck Obstruction ..................................... 490
28.1.2 Prostatic Utricle Cyst (Utricular Cyst), Remnants
of the Müllerian Ducts ........................................... 491
28.1.3 Posterior Urethral Valves ....................................... 492
28.1.4 Other Rare Urethral Pathologies ........................... 495
28.1.5 Urethral Stenosis and Stricture .............................. 496
28.1.6 Meatal Stenosis ...................................................... 497
28.1.7 Urethral Diverticulum ............................................ 498
Contents xxiii
28.1.8 Labial Synechia (Fusion) ......................................... 498
28.1.9 Interlabial (Intralabial) Masses ................................ 499
28.2 Neurogenic Bladder ............................................................ 499
28.3 Dysfunctional Voiding (Functional Urinary Incontinence,
Dysfunctional Elimination Syndromes) ............................. 500
28.4 Acute and Chronic Urinary Retention................................. 502
28.4.1 Acute Urinary Retention .......................................... 503
28.4.2 Chronic Urinary Retention ...................................... 503
28.5 Bladder Exstrophy, Epispadias, Cloacal Anomalies,
and Duplex Kidney.............................................................. 503
Webcodes ....................................................................................... 504
Bibliography .................................................................................. 504
29 Genital Bleedings, Vaginal Discharge,
and Interlabial Masses ................................................................. 507
29.1 Physiological Hemorrhages ................................................ 507
29.2 Pathological Hemorrhages and Vaginal Discharge ............. 507
29.2.1 Benign and Malignant Tumors ................................ 508
29.2.2 Vulvovaginitis .......................................................... 509
29.2.3 Vaginal Foreign Body .............................................. 509
29.2.4 Genital Injuries ........................................................ 510
29.2.5 Sexual Abuse ........................................................... 511
29.3 Interlabial (Intralabial) Masses ........................................... 513
Webcodes ....................................................................................... 514
Bibliography .................................................................................. 515
30 Testicular and/or Scrotal Swelling (Pain) .................................. 517
30.1 Testicular Torsion (Torsion of the Spermatic Cord) ............ 518
30.2 Epididymitis ........................................................................ 520
30.3 Torsion of the Testicular and Paratesticular Appendages ... 522
30.4 Scrotal Injury, Zipper Entrapment ....................................... 522
30.5 Testicular Hydrocele or Hydrocele of the Cord
and Complete Inguinal Hernia ............................................ 524
30.6 Acute Idiopathic Scrotal Edema (Scrotal Wall Edema) ...... 524
30.7 Insect Stings and Bites ........................................................ 525
30.8 Henoch-Schönlein Purpura with Scrotal Involvement ........ 525
30.9 Orchitis ................................................................................ 526
30.10 Other Inflammatory Disorders of the Scrotum.................... 527
30.11 Peritoneal Disorders ............................................................ 527
30.12 Varicocele ............................................................................ 527
30.13 Testicular Tumor ................................................................. 528
Webcodes ....................................................................................... 530
Bibliography .................................................................................. 530
31 Cryptorchidism, Empty Scrotum ............................................... 535
31.1 Testicular Retention and Ectopy ......................................... 535
31.1.1 Abdominal Testis ..................................................... 536
31.1.2 Prefascial Ectopy or Sliding Testis .......................... 536
31.1.3 The Transverse Ectopy ............................................ 536
xxiv Contents
31.2 Secondary Cryptorchidism .................................................. 536
31.3 Clinical Presentation and Skills in Cryptorchidism ............ 536
31.4 Differential Diagnosis and Work-Ups in Cryptorchidism ... 537
31.5 Treatment and Prognosis of Cryptorchidism ...................... 538
Webcodes ....................................................................................... 540
Bibliography .................................................................................. 540
32 Conspicuous External Genitals in the Boy ................................ 543
32.1 Epispadias ........................................................................... 543
32.2 Hypospadias ........................................................................ 544
32.3 Micropenis........................................................................... 548
32.4 Penis Torsion, Lateral Deviation of the Penis ..................... 549
32.5 Other Rare Malformations of the Penis .............................. 550
32.6 Priapism............................................................................... 550
Webcodes ....................................................................................... 552
Bibliography .................................................................................. 552
33 Conspicuous External Genitals in a Girl ................................... 555
33.1 Epispadias in a Girl ............................................................. 555
33.2 Hypospadias and Interlabial Masses ................................... 556
33.3 Congenital Obstructions of the Genital Tract
(Gynatresias) ....................................................................... 556
33.3.1 Imperforate Hymen.................................................. 556
33.3.2 Other Transverse Congenital Vaginal
Obstructions, Vaginal Agenesis ............................... 557
33.3.3 Duplications of Vagina and Uterus
(Fusion Anomalies) ................................................. 558
33.3.4 Urogenital Sinus, Cloacal Anomalies...................... 559
33.4 Variations of Normality, Acquired Disorders ...................... 562
33.5 Injuries of the External Genitals
and Female Genital Mutilation............................................ 563
33.5.1 Female Genital Mutilation
(Female Genital Cutting, Female Circumcision) .... 536
Webcodes ....................................................................................... 564
Bibliography .................................................................................. 564
34 Ambiguous External Genitals, Disorders
of Sex Development (DSD) .......................................................... 567
34.1 Newborns ............................................................................ 570
34.1.1 46, XX Disorders of Sex Development
(Female Pseudohermaphroditism) ........................... 570
34.1.2 46, XY Disorder of Sex Development
(Male Hermaphroditism #) ...................................... 571
34.1.3 Chromosomal Disorders of Sex Development ........ 574
34.2 Infants and Older Children .................................................. 574
34.2.1 46, XX DSD (Female Pseudohermaphroditism) ..... 575
34.2.2 46, XY DSD (Male Pseudohermaphroditism) ........ 575
34.2.3 Chromosomal Disorders of Sex Development ........ 576
Webcodes ....................................................................................... 577
Bibliography .................................................................................. 577
Contents xxv
Part VI Back
35 Masses, Fistulas, and Skin Abnormalities of the Back ............. 583
35.1 Myelomeningocele, Meningocele,
Lipomyelomeningocele ....................................................... 583
35.2 Minimal Spinal Dysraphism
(Occult Spinal Dysraphism, Spina Bifida Occulta)............. 589
35.3 Sacrococcygeal Teratoma .................................................... 594
35.4 Dermal Sinus of the Coccyx ............................................... 595
Webcodes ....................................................................................... 596
Bibliography .................................................................................. 596
36 Blended Learning and Formative Assessments
for Specialist Training and Continuing Education
in Pediatric Surgery ..................................................................... 599
36.1 Blended Learning with psurg.net ........................................ 599
36.2 Formative Assessment at psurg.net ..................................... 600
36.3 Selected Content for Undergraduate Medical Students ...... 600
36.4 Certification of Advanced Training
and Continuing Education with psurg.net ........................... 600
Bibliography .................................................................................. 600
Index ...................................................................................................... 603

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