Handbook of Pediatric Surgery

Chandrasen K. Sinha • Mark Davenport (Eds.)

Handbook of Pediatric Surgery

ISBN: 978-1-84882-131-6 e-ISBN: 978-1-84882-132-3DOI: 10.1007/978-1-84882-132-3Springer Dordrecht Heidelberg London New York

Library of Congress Control Number: 2010920242

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Chandrasen K. Sinha, MBBS (Honours) MS MCh(Paediatric Surgery) FRCSEd FRCSI FRCS(Paeds)Department of Paediatric SurgeryKings College HospitalLondonUK

Mark Davenport, ChM FRCS(Eng) FRCPS(Glas) FRCS(Paeds)Department of Paediatric SurgeryKings College HospitalLondonUK

A good surgeon is a doctor who can operate and knows when not to operate!Theodore Kocker (1841–1917)

It is usually a bad sign if the anesthetist is asking you if you are losing a lot of blood during a case – especially when you’re not!

Michael Hoffman

It is usually a bad sign if there are three or more anesthetists are in the operating room at the same time and none of them is reading the newspaper!

Michael Hoffman

If an operation is difficult you are not doing it properly.(This philosophy of perfection characterized the brilliant surgical career of Robert E. Gross, spanning 40 years from 1927 to 1967, at Harvard Medical School, Children’s Hospital and Peter Bent Brigham Hospital.)

Be not the first to whom the new is tried, nor the last to lay the old aside

When technology is the master, the result is disaster.

Human mind works best like parachute – works best when open!Chinese proverb

Hippocratic OathIt was developed and written in Greek in the 4th century bc. It has been widely quoted by all graduates. It contains fundamental doctrine (do no harm, do not induce abortion or practice euthanasia), which is still pertinent today despite the gap of over two millennia.

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.I will prescribe regimens for the good of my patients according to my ability and my judg-ment and never do harm to anyone.I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.But I will preserve the purity of my life and my arts.I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

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Preface

Pediatric surgery was a late starter, breaking off from general surgery only in the last 50 years or so. The surgeons who practised it were a small, often self-selected group who typically dedicated their surgical lives to the care of infants and children. That genera-tion would often have been available round the clock, for most days of the week, simply because there was no-one else to do the job. When they did get out, to discuss cases and compare notes, it was often across borders to meet like-minded people from overseas or out-of town. Thus, like no other specialty, pediatric surgery is an international specialty, suffering much less from parochial constraints and much more receptive to ideas from the outside.

We hope this book helps all those involved in the surgical care of the child (including general practitioners, general surgeons, accident & emergency doctors, and pediatricians) to arrive at the correct decision and improve the quality of their care. However, any advice regarding further improvement of this book will be most welcomed. This book should also be helpful for trainees (especially pediatric surgery, general surgery, pediatric medicine and MEDICAL STUDENTS) preparing for various examinations.

The overriding aim and guiding principle of this book was to utilize capable surgeons as authors from across the world. They are the acclaimed experts in their field, and we thank them and have tried to capture their knowledge and essence within the constraints of a concise, general textbook.

Chandrasen K. Sinha Mark Davenport

London, UK

We gratefully acknowledge the role of Melissa Morton, Denise Roland and Balasaraswathi Jayakumar (Springer), who were very encouraging and steered us smoothly through this turbulent journey.

CKS dedicates this work to Uma, Leena, Ankit, and Akarsh. MD acknowledges the patience and forbearance of his family and dedicates this work, as always, to Keren and Georgina.

Acknowledgements

ix

xi

Contents

Part I Milestones in Pediatric Surgery

1.1 Milestones in Pediatric Surgery ........................................................................ 3Mark Davenport

Part II Principles of Surgical Science

2.1 Fluids, Electrolytes, and Dehydration .............................................................. 9Mark Davenport and Shamhed H. S. Syed

2.2 Metabolic Response to Injury and Sepsis ......................................................... 21Mark Davenport

2.3 Shock .................................................................................................................... 25Mark Davenport

2.4 Parenteral Nutrition ........................................................................................... 29Chandrasen K. Sinha, Shamshed H.S. Syed and Rupert Hinds

2.5 Hematology for Surgeons .................................................................................. 35 Mark Davenport

2.6 Postoperative Problems ...................................................................................... 43Mark Davenport

2.7 Neonatal Physiology and Care .......................................................................... 49Vadivelam Murthy, Chandrasen K. Sinha, Ravindra Bhat, and Mark Davenport

Part III Fetal and Neonatal Surgery

3.1 Fetal Surgery: General Principles .................................................................... 59Eric B. Jelin and Hanmin Lee

3.2 Diaphragmatic Hernia ....................................................................................... 69Saidul Islam, Chandrasen K. Sinha, and Mark Davenport

3.3 Esophageal Atresia ............................................................................................. 77Chandrasen K. Sinha and Lewis Spitz

3.4 Pyloric Stenosis ................................................................................................... 85Giorgia Totonelli and Denis A. Cozzi

3.5 Malrotation ......................................................................................................... 89Ike L. Njere and Mark Davenport

3.6 Intestinal Atresia ................................................................................................ 95Chandrasen K. Sinha, Erica Makin, and Dorothy Iwagba Kufeji

3.7 Necrotizing Entercolitis ...................................................................................... 103Lorna Cook and Mark Davenport

3.8 Meconium Ileus ................................................................................................... 109Chandrasen K. Sinha, Mark Davenport, and Harry C. Ward

3.9 Hirschsprung’s Disease ...................................................................................... 117Tariq Burki, Chandrasen K. Sinha, and Atsuyuki Yamataka

3.10 Anorectal Malformations ................................................................................... 125Chandrasen K. Sinha, Marc A. Levitt, and Alberto Peña

3.11 Abdominal Wall Defects .................................................................................... 133Chandrasen K. Sinha and Mark Davenport

Part IV Children’s Surgery

4.1 Surgical Neck Pathology .................................................................................... 141Chandrasen K. Sinha, Meena Agrawal, and Mark Davenport

4.2 Developmental Lung Anomalies ....................................................................... 151Abid Q. Qazi, Chandrasen K. Sinha, and Mark Davenport

4.3 Gastro-Esophageal Reflux ................................................................................. 159Chandrasen K. Sinha and Benno Ure

4.4 Gastrointestinal Bleeding ................................................................................... 167Juan A. Tovar

xii Contents

Contents xiii

4.5 Acute Abdomen .................................................................................................. 173Pablo Laje and Marcelo Martinez-Ferro

4.6 Intussusception ................................................................................................... 177Prema Ambalakat Menon and Katragadda L. N. Rao

4.7 Appendicitis ........................................................................................................ 183Ciro Esposito

4.8 Rare Causes of Abdominal Pain ....................................................................... 189Mark Davenport

4.9 Crohn’s Disease .................................................................................................. 193Chandrasen K. Sinha and Arnold G. Coran

4.10 Ulcerative Colitis ................................................................................................ 201Chandrasen K. Sinha and Arnold G. Coran

4.11 Short Bowel Syndrome ....................................................................................... 207Mark Davenport

4.12 Intestinal Transplantation ................................................................................. 213Alastair J. W. Millar and Girish Gupte

4.13 Vascular Malformations..................................................................................... 221Ramnik V. Patel and Joseph. I. Curry

4.14 Inguinal Hernias and Hydroceles...................................................................... 229Victoria Scott, Mark Davenport, and Ross M. Fisher

4.15 The Acute Scrotum ............................................................................................. 235 Mark Davenport

4.16 The Undescended Testes .................................................................................... 239Chandrasen K. Sinha and John M. Hutson

4.17 Miscellaneous Problems of the Male Genitalia ................................................ 245Mark Davenport

4.18 Miscellaneous Surgical Issues ............................................................................ 251Jean W. L. Wong, Chandrasen K. Sinha, and Mark Davenport

4.19 Basic Pediatric Laparoscopy and Thoracoscopy ............................................. 257Steven S. Rothenberg and Suzanne M. Yoder

xiv Contents

Part V Principles of Pediatric Urology

5.1 Urinary Tract Infection ...................................................................................... 271Chandrasen K. Sinha, Anand Pandey, and Devesh Misra

5.2 The Ureter ........................................................................................................... 277Dinesh Kumar Gupta, Vijai D. Upadhyaya and S. P. Sharma

5.3 Vesico-Ureteric Reflux ....................................................................................... 287Devendra K. Gupta and Shilpa Sharma

5.4 Neurogenic Bladder ............................................................................................ 293George Ninan

5.5 Posterior Urethral Valves .................................................................................. 299Milan Gopal and Ashok Rajimwale

5.6 Hypospadias ........................................................................................................ 307Vibhash C. Mishra and Hanif G. Motiwala

5.7 Bladder Exstrophy, Epispadias, and Cloacal Exstrophy ................................ 313Bharat More and Imran Mushtaq

5.8 Disorders of Sex Development ........................................................................... 321Nitin V. Patwardhan, M. Woodward, and G. Nicholls

Part VI Surgery of the Liver, Pancreas and Bile Ducts

6.1 Investigation of Jaundice ................................................................................... 329Christopher J. Parsons and Mark Davenport

6.2 Biliary Atresia ..................................................................................................... 335Chandrasen K. Sinha and Mark Davenport

6.3 Choledochal Malformations .............................................................................. 341Chandrasen K. Sinha and Mark Davenport

6.4 Gallbladder Disease ............................................................................................ 345Chandrasen K. Sinha, Masih A. Kadar, and Mark Davenport

6.5 Portal Hypertension ........................................................................................... 349Chandrasen K. Sinha and Mark Davenport

Contents xv

6.6 Pancreatic Disease .............................................................................................. 355Chandrasen K. Sinha and Mark Davenport

6.7 Liver Transplantation ........................................................................................ 363Jonathan S. Karpelowsky and Alastair J. W. Millar

Part VII Principles of Surgical Oncology

7.1 Wilms’ Tumor ..................................................................................................... 375Ramnik V. Patel, Chandrasen K. Sinha, Shawqui Nour, and Jenny Walker

7.2 Liver Tumors....................................................................................................... 383Chandrasen K. Sinha and Mark Davenport

7.3 Neuroblastoma .................................................................................................... 391Nadeem Haider and Roly Squire

7.4 Teratomas ............................................................................................................ 399Erica Makin and Mark Davenport

7.5 Miscellaneous Tumors ........................................................................................ 405Anindya Niyogi, Chandrasen K. Sinha, and Robert Carachi

Part VIII Principles of Trauma

8.1 Trauma Management: General Principles ....................................................... 419Shailesh B. Patel

8.2 Abdominal Trauma ............................................................................................ 429Ramnik V. Patel, Emmanuel M. L. Endeley, Mark Davenport,

and Jenny Walker

8.3 Thoracic Trauma ................................................................................................ 439Mark Davenport

8.4 Basic Brain Injury .............................................................................................. 445Mark Davenport

Part IX Spina Bifida and Hydrocephalus

9.1 Spina Bifida ......................................................................................................... 451Ajay N. Gangopadhyay, Vijai D. Upadhyaya, and Anand Pandey

xvi Contents

9.2 Hydrocephalus .................................................................................................... 459Ajay N. Gangopadhyay, Vijai D. Upadhyaya, and Anand Pandey

Part X Appendices

10.1 Reference Weights and Heights ......................................................................... 469Mark Davenport

10.2 Anatomical Reference ........................................................................................ 471 Mark Davenport

10.3 Human Developmental Milestones ................................................................... 475Mark Davenport

Index .............................................................................................................................. 479

Contributors

Meena AgrawalPaediatric Surgery Department,Children’s Hospital at University Hospital Lewisham, London, UKEvelina Children’s Hospital, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK

Ravindra BhatChild Health Department, Kings College Hospital, London, UK

Tariq BurkiPaediatric Surgery Department, Bristol Children’s Hospital, Bristol, UK

Robert CarachiSurgical Paediatrics Department, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK

Lorna CookDepartment of Paediatric Surgery, Kings College Hospital, London, UK

Arnold G. CoranSection of Pediatric Surgery, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA

Denis A. CozziPediatric Surgery Unit, Sapienza University of Rome and Policlinico Umberto I, Rome, Italy

Joseph I. CurryPaediatric Surgery Department, Great Ormond Street Children’s Hospital, London, UK

Mark DavenportPaediatric Surgery Department, Kings College Hospital, London, UK

Emmanuel M.L. EndeleyPaediatric A&E, Buckinghamshire Hospitals – Wycombe and Mandeville Hospitals, Mandeville, UK

Ciro EspositoPediatrics Department, “Federico II” University of Naples, Naples, Italy

Ross M. FisherDepartment of Paediatric Surgery, The Children’s Hospital, Leicester Royal Infirmary, Leicester, UK

xvii

xviii Contributors

Ajay N. GangopadhyayDepartment of Pediatric Surgery, Institute of Medical Sciences, BHU, Varanasi, India

Milan GopalPaediatric Surgery Department, Royal Victoria Infirmary, Newcastle Upon Tyne, UK

Dinesh K. GuptaPaediatric Surgery Department, Institute of Medical Sciences, Varanasi, India

Devendra K. GuptaDepartment of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

Girish GupteLiver Unit, Birmingham Children’s Hospital, Birmingham, UK

Nadeem HaiderPaediatric Surgery Department, Leeds General Infirmary, Leeds, UK

Rupert HindsDepartment of Paediatrics, Monash Medical Centre, Melbourne, Australia

John M. HutsonDepartment of Paediatrics, University of Melbourne, Melbourne, Australia Urology Department, Royal Children’s Hospital, Melbourne, Australia

Saidul IslamPaediatric Surgery Department, Great Ormond Street Hospital for Children, London, UK

Eric B. JelinDepartment of Surgery, Division of Pediatric Surgery/Fetal Treatment Center, University of California at San Francisco, San Francisco, CA, USA

Masih A. KaderPaediatric Surgery Department, University Hospital Lewisham, London, UK

Jonathan S. KarpelowskyPaediatric Surgery, University of Cape Town, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

Dorothy Iwagba KufejiDepartment of Paediatric Surgery, Evelina Children’s Hospital, St Thomas’ Hospital, London, UK

Vijai KumarPaediatric Surgery Department, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India

Pablo LajeDepartment of Pediatric Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Hanmin LeeDepartment of Surgery, Division of Pediatric Surgery/Fetal Treatment Center, University of California at San Francisco, San Francisco, CA, USA

Marc A. LevittColorectal Centre, Cincinnati Children’s Hospital, USA

Contributors xix

Erica MakinPaediatric Surgery Department, King’s College Hospital, London, UK

Marcelo Martinez-FerroDepartment of Pediatric Surgery, Fundación Hospitalaria de Niños, Buenos Aires, Argentina

Prema A. MenonPediatric Surgery Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Alastair J.W. MillarDepartment of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa

Vibhash C. MishraUrology Department, Wexham Park Hospital, Slough, UK

Devesh MisraPaediatric Surgery Department, Royal London Hospital, London, UK

Bharat MorePaediatric Urology Department, Great Ormond Street Hospital, London, UK

Hanif G. MotiwalaUrology Department, Wexham Park Hospital, Slough, UK

Vadivelam MurthyDepartment of Neonatology, Kings College Hospital, London, UK

Imran MushtaqPaediatric Urology, Great Ormond Street Hospital, Great Ormond Street, London, UK

Guy NichollsPaediatric Surgery Department, Bristol Children’s Hospital, Bristol, UK

George NinanPaediatric Surgery Department, Leicester Royal Infirmary, Leicester, UK

Anindya NiyogiPaediatric Surgery Department, Chelsea and Westminster Hospital, London, UK

Ike L. NjereDepartment of Paediatric Surgery, University Hospital Lewisham, London, UK

Shawqui NourPaediatric Surgery Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK

Anand PandeyDepartment of Paediatric Surgery, Chhatrapati Shahuji Maharaj Medical University, Lucknow, UP, India

Christopher J. ParsonsPaediatric Surgery Department, King’s College Hospital, London, UK

Ramnik V. PatelDepartment of Paediatric Surgery, Sheffield Children’s Hospital, London, UK

xx Contributors

Shailesh B. PatelDepartment of Paediatric Surgery, King’s College Hospital, London, UK

Nitin PatwardhanPaediatric Surgery Department, Bristol Children’s Hospital, Bristol, UK

Alberto PeñaDepartment of Pediatric Surgery, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, OH, USA

Abid Q. QaziPaediatric Surgery Department, Sheffield Children’s Hospital, Sheffield, UK

Ashok RajimwalePaediatric Surgery Department, Leicester Royal Infirmary, Leicester, UK

Katragadda L.N. RaoPediatric Surgery, Post Graduate Institute of Medical Education and Research, Advanced Pediatrics Centre, Chandigarh, India

Steven S. RothenbergPediatric Surgery Department, Rocky Mountain Hospital for Children, Denver, CO, USA

V. ScottPaediatric Surgery Department, Leicester Royal Infirmary, Leicester, UK

S.P. SharmaDepartment of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India

Chandrasen K. SinhaPaediatric Surgery Department, King’s College Hospital, London, UK

Lewis SpitzEmeritus Nuffield Professor of Paediatric Surgery, Institute of Child Health, London, UK

Roly SquirePaediatric Surgery Department, Leeds Teaching Hospitals, St James’ University Hospital, Leeds, UK

Shamshad H.S. SyedPaediatric Surgery Department, Chelsea and Westminster Hospital, London, UK

Giorgia TotonelliPediatric Surgery Unit, Sapienza University of Rome, Rome, Italy

Juan A. TovarDepartment of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

Vijai D. UpadhyayaDepartment of Surgery, MGM Medical College, Indore, India

Benno UreDepartment of Pediatric Surgery, Medical School Hannover, Hannover, Germany

Jenny WalkerPaediatric Surgery Department, Sheffield Children’s Hospital, Sheffield, UK

Contributors xxi

Harry C. WardPaediatric Surgery Department, Barts and the London NHS Trust, Royal London Hospital, London, UK

Jean W.L. WongPaediatric Surgery Department, University Hospital Lewisham, London, UK

Mark WoodwardPaediatric Surgery Department, Bristol Children’s Hospital, Bristol, UK

Atsuyuki YamatakaPediatric Surgery and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan

Suzanne M. YoderPediatric Surgery Department, The Rocky Mountain Hospital for Children, Denver, CO, USA