(BQ) Part 1 book Jones’ clinical paediatric surgery has contents: Antenatal diagnosis - Surgical aspects, the care and transport of the newborn, the child in hospital, respiratory distress in the newborn, congenital diaphragmatic hernia,... and other contents.
Jones’ Clinical Paediatric Surgery Jones’ Clinical Paediatric Surgery Ed ite d by John M Hutson AO, MD, DSc (Melb), MD (Monash), FRACS, FAAP Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia Chair of Paediatric Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia Michael O’Brien PhD, FRCSI (Paed) Department of Paediatric Urology, Royal Children’s Hospital, Parkville, Victoria, Australia Chief of Division of Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia Spencer W Beasley MS, FRACS Professor of Paediatric Surgery, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand Clinical Director, Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand Warwick J Teague DPhil (Oxon), FRACS Department of Paediatric and Neonatal Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia Sebastian K King PhD, FRACS (Paed) Department of Paediatric and Neonatal Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia S e v e nth Ed ition This edition first published 2015; © 2008, 2015 by John Wiley & Sons, Ltd Registered office John Wiley & Sons, Ltd., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices 9600 Garsington Road, Oxford, OX4 2DQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book It is sold on the understanding that the publisher is not engaged in rendering professional services If professional advice or other expert assistance is required, the services of a competent professional should be sought The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data Jones’ clinical paediatric surgery / edited by John M Hutson, Michael O’Brien, Spencer W Beasley, Warwick J Teague, Sebastian K King – Seventh edition p ; cm Clinical paediatric surgery Includes bibliographical references and index ISBN 978-1-118-77731-2 (cloth) I. Hutson, John M., editor. II. O’Brien, Michael (Pediatric urologist), editor. III. Beasley, Spencer W., editor. IV. Teague, Warwick J., editor. V. King, Sebastian K., editor. VI. Title: Clinical paediatric surgery [DNLM: 1. Child. 2. Infant, Newborn. 3. Infant. 4. Surgical Procedures, Operative. 5. Pediatrics–methods. WO 925] RD137 617.9′8–dc23 2014028289 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Cover Image: 06-22-05 © fkienas Operation Stock Image:662290 Set in 8.5/12pt Meridien by SPi Publisher Services, Pondicherry, India 1 2015 Contents Contributors, vii PART IV: Abdomen Foreword to the first edition by Mark M Ravitch, viii 17 The Umbilicus, 117 Tribute to Mr Peter Jones, ix Preface to the seventh edition, x Acknowledgements, xi PART I: Introduction Antenatal Diagnosis: Surgical Aspects, 2 The care and transport of the newborn, The Child in Hospital, 13 PART II: Neonatal Emergencies 4 Respiratory distress in the newborn, 19 Congenital Diaphragmatic Hernia, 26 Oesophageal Atresia 18 Vomiting in the First Months of Life, 121 19 Intussusception, 126 20 Abdominal Pain: Appendicitis?, 130 21 Recurrent Abdominal Pain, 136 22 Constipation, 139 23 Bleeding from the Alimentary Canal, 142 24 Inflammatory Bowel Disease, 147 25 The Child with an Abdominal Mass, 153 26 Spleen, Pancreas and Biliary Tract, 158 27 Anus, Perineum and Female Genitalia, 164 28 Undescended Testes and Varicocele, 171 29 Inguinal Region and Acute Scrotum, 175 30 The Penis, 183 and Tracheo-oesophageal Fistula, 30 Bowel Obstruction, 35 PART V: Urinary Tract Abdominal Wall Defects, 45 31 Urinary Tract Infection, 191 Spina Bifida, 50 32 Vesico-ureteric Reflux (VUR), 197 10 Disorders of sex development, 57 33 Urinary Tract Dilatation, 202 11 Anorectal Malformations, 62 34 The Child with Wetting, 209 35 The Child with Haematuria, 215 PART III: Head and Neck 12 The Scalp, Skull and Brain, 69 PART VI: Trauma 13 The Eye, 80 36 Trauma in Childhood, 221 14 The Ear, Nose and Throat, 91 37 Head Injuries, 228 15 Cleft Lip, Palate and Craniofacial Anomalies, 97 38 Abdominal and Thoracic Trauma, 235 16 Abnormalities of the Neck and Face, 106 39 Foreign Bodies, 241 v vi Contents 40 The Ingestion of Corrosives, 247 PART VIII: Chest 41 Burns, 249 47 The Breast, 287 48 Chest Wall Deformities, 290 PART VII: Orthopaedics 49 Lungs, Pleura and Mediastinum, 294 42 Neonatal Orthopaedics, 257 43 Orthopaedics in the Infant and Toddler, 262 PART IX: Skin and Soft Tissues 44 Orthopaedics in the Child, 267 50 Vascular and Pigmented Naevi, 303 45 Orthopaedics in the Teenager, 275 51 Soft Tissue Lumps, 308 46 The Hand, 280 52 Answers to Case Questions, 311 Index, 317 Contributors Spencer W Beasley, MS, FRACS Professor of Paediatric Surgery, Christchurch School of Medicine, University of Otago Clinical Director, Department of Paediatric Surgery, Christchurch Hospital Christchurch, New Zealand Robert Berkowitz, MD, FRACS Department of Otolaryngology Royal Children’s Hospital Parkville, Victoria, Australia Thomas Clarnette, MD, FRACS Department of Paediatric and Neonatal Surgery Royal Children’s Hospital Parkville, Victoria, Australia Joe Crameri, FRACS Department of Paediatric and Neonatal Surgery Royal Children’s Hospital Parkville, Victoria, Australia James E Elder, FRACO, FRACS Department of Ophthalmology Royal Children’s Hospital Parkville, Victoria, Australia Kerr Graham, MD, FRCS (Ed) Professor of Orthopaedics Royal Children’s Hospital Parkville, Victoria, Australia Anthony Holmes, FRACS Diplomate, American Board of Plastic Surgery; Plastic and Maxillofacial Surgery Department Royal Children’s Hospital Parkville, Victoria, Australia John M Hutson, AO, MD, DSc (Melb), MD (Monash), Chair of Paediatric Surgery Royal Children’s Hospital Parkville, Victoria, Australia Bruce R Johnstone, FRACS Department of Plastic and Maxillofacial Surgery Royal Children’s Hospital Parkville, Victoria, Australia Sebastian K King, PhD, FRACS Department of Paediatric and Neonatal Surgery Royal Children’s Hospital, Parkville, Victoria, Australia Wirginia J Maixner, FRACS Neuroscience Centre Royal Children’s Hospital Parkville, Victoria, Australia Michael O’Brien, PhD, FRCSI (Paed) Department of Paediatric Urology; Chief of Division of Surgery Royal Children’s Hospital Parkville, Victoria, Australia Anthony J Penington, FRACS Professor of Plastic Surgery Royal Children’s Hospital Parkville, Victoria, Australia Russell G Taylor, FRACS Department of Paediatric and Neonatal Surgery Royal Children’s Hospital Parkville, Victoria, Australia Warwick J Teague, DPhil (Oxon), FRACS Department of Paediatric and Neonatal Surgery Royal Children’s Hospital Parkville, Victoria, Australia FRACS, FAAP Department of Paediatrics University of Melbourne Melbourne, Victoria, Australia and vii Foreword to the First Edition The progressive increase in the body of information relative to the surgical specialities has come to present a vexing problem in the instruction of medical students There is only enough time in the medical curriculum to present an overview to them, and in textbook material, one is reduced either to synoptic sections in textbooks of surgery or to the speciality too detailed for the student or the non-specialist in complete and authoritative textbooks There has long been a need for a book of modest size dealing with paediatric surgery in a way suited to the requirements of the medical student, general practitioner and paediatrician Peter G Jones and his associates from the distinguished and productive group at the Royal Children’s Hospital in Melbourne have succeeded in meeting this need The book could have been entitled Surgical Conditions in Infancy and Childhood, for it deals with children and their afflictions, their symptoms, diagnosis and treatment rather than surgery as such The reader is told when and how urgently an operation is required, and enough about the nature of the procedure to understand its risks and appreciate its results This is what students need to know and what paediatricians and general practitioners need to be refreshed on Many of the chapters are novel, in that they deal not with categorical diseases but with the conditions viii that give rise to a specific symptom – Vomiting in the First Month of Life, The Jaundiced Newborn Baby, Surgical Causes of Failure to Thrive The chapter on genetic counselling is a model of information and good sense The book is systematic and thorough A clean style, logical sequential discussions and avoidance of esoterica allow the presentation of substantial information over the entire field of paediatric surgery in this comfortablesized volume with well-chosen illustrations and carefully selected bibliography Many charts and tables, original in conception, enhance the clear presentation No other book so satisfactorily meets the need of the student for broad and authoritative coverage in a modest compass The paediatric house officer (in whose hospital more than 50% of the patients are, after all, surgical) will be serviced equally well Paediatric surgeons will find between these covers an account of the attitudes, practices and results of one of the world’s greatest paediatric surgical centres The book comes as a fitting tribute to the 100th anniversary of the Royal Children’s Hospital Mark M Ravitch Professor of Paediatric Surgery University of Pennsylvania 174 Part IV: Abdomen patient is standing and feels like a bag of worms Varicoceles are usually left sided (80–90%) but may be right sided in 1–7% or bilateral in 2–20% There is sometimes a small secondary hydrocele and the hemi-scrotum is redundant The varicosities typically empty when the boy lies down (but the left hemi-scrotum remains more pendulous than the right); thus, clinical examination should always include getting the boy to stand up The varicocele is usually symptomless, though a dragging ache may develop when the varicocele is large The normal pampiniform plexus helps control the temperature of the testis, by cooling the arterial blood flowing to the testis through a countercurrent heat exchange The loss of this cooling mechanism affects both testes and the consequent rise of scrotal temperature towards normal body temperature may cause oligospermia While varicoceles are present in 10–20% of the normal male population, a subclinical varicocele is found in 40–75% of males investigated for infertility tumour, neuroblastoma) It is exceptionally rare for retroperitoneal tumours to present in this way: the tumour will more often present as a palpable mass with or without haematuria and hypertension Key Points • Undescended testes (UDT) are common • Congenital UDT should be confirmed at months of age after postnatal descent is complete • Congenital UDT should be referred for an operation at 6–12 months • Acquired UDT should be screened for in 4–10-year-olds and referred for a possible operation if the testis does not reside in scrotum • Varicocele should be suspected in adolescents who have a pendulous left hemi-scrotum • Varicocele diagnosis is confirmed on standing and then referred for surgical assessment Treatment The normal scrotal temperature is 33°C (4°C below body temperature) This is the optimal temperature for spermatogenesis Relative infertility cannot be assessed until late adolescence, but secondary atrophy of the ipsilateral testis is well recognised, and if the affected testis is significantly smaller or softer in texture than the contralateral testis, then early operative intervention is indicated Laparoscopic ligation (Palomo operation) of the spermatic vessels should prevent recurrence in most patients, although there are many other techniques Very rarely, a varicocele is caused by obstruction of the renal veins by a retroperitoneal tumour (e.g Wilms Further reading Hutson JM (2006) Undescended testis, torsion and varicocele In: Coran AG, Adzick NA, Krummel TM, Laberge J-M, Shamberger RC, Caldamore AA (eds) Pediatric Surgery, 7th Edn Elsevier Saunders, Philadelphia, pp 1003–1020 Hutson JM, Southwell BR, Li R et al (2013) The regulation of testicular descent and the effects of cryptorchidism Endocr Rev 34(5): 725–752 Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O (2007) Age at surgery for undescended testis and risk of testicular cancer N Engl J Med 356: 1835–1841 C h apter 2 Inguinal Region and Acute Scrotum Case Case A 6-month-old boy presents with an intermittent swelling in the left groin Both testes are in the scrotum Q 1.1 What is the likely diagnosis? Q 1.2 What is the treatment? A 7-year-old boy complains of pain and swelling in the right scrotum for 6 h He had mumps recently Q 2.1 What is the differential diagnosis? Q 2.2 Could he have mumps orchitis? Q 2.3 What is the treatment? The inguinoscrotal region is the most common site for surgical conditions in childhood As the area is readily accessible to inspection and palpation, accurate diagnosis is easy, but depends upon a knowledge of normal anatomy and the many conditions occurring in the area The inguinoscrotal region is not isolated from the rest of the body Symptoms and signs may arise here in systemic diseases, and vice versa, for example, blood or meconium in the tunica vaginalis from intraperitoneal haemorrhage or meconium peritonitis, or torsion of the testis presenting with pain referred to the abdomen A careful examination of the inguinoscrotal region, and of the whole patient, is necessary to avoid diagnostic errors The acute scrotum Several conditions cause a red, swollen and painful scrotum [Table 29.1], with wide variations in speed of onset, rate of progression and local signs and the severity of pain [Fig. 29.1] Torsion of the testis Testicular torsion is not the most common cause of an acute scrotum, but it is the most important The spermatic cord undergoes torsion, obstructing the spermatic vessels, and is a surgical emergency because of the high incidence of testicular infarction if the cord is not untwisted promptly The risk of torsion is greatest just after the testis enlarges at puberty in 12–16-year-olds Also, the risk is increased in unoperated undescended testes Two kinds of torsion occur: Intratunical (or intravaginal), the more common, is made possible by an abnormally narrow base of the mesenteric attachment of the testis and epididymis within the tunica vaginalis The predisposing abnormality is almost always present on the contralateral side as well, and this testis should be fixed at the time of operation to prevent metachronous torsion Rarely, torsion occurs between the testis and the epididymis, which are connected by a thin sheet of tissue Unoperated undescended testes are at an increased risk, as their fixation within the tunica is commonly tenuous Extratunical (or extravaginal) torsion is rare During testicular descent, a plane of mobility between the tunica vaginalis and surrounding areolar tissue permits testicular migration to the scrotum The tunica becomes fixed to the scrotum after descent, but prior to fixation, an interval of torsion-permitting mobility exists In accordance with this timing interval, extravaginal torsion typically occurs either just before birth or in the early neonatal period The testis is almost always necrotic by the time the diagnosis is made Jones’ Clinical Paediatric Surgery, Seventh Edition Edited by John M Hutson, Michael O’Brien, Spencer W Beasley, Warwick J Teague and Sebastian K King © 2015 John Wiley & Sons, Ltd Published 2015 by John Wiley & Sons, Ltd 175 176 Part IV: Abdomen Treatment Table 29.1 Causes of acute scrotum in children Torsion of testicular appendage (Hydatid of Morgagni) Torsion of the testis itself Epididymo-orchitis Idiopathic scrotal oedema 60% 30%