Atlas of Paediatric Surgery with Mcqs in Paediatric Surgery

By Dr. Muhammad Khalid Syed

This book is the unique book with combination of colour atlas of Paediatric surgery and MCQs in Paediatric surgery.

In Colour Atlas patient’s photos, X-rays, CT scan and MRI can be seen. Among patient’s photos there are pre-operative and per-operative photos, as well as photos of complications.

My other book “MCQs in Paediatric surgery” also has been merged in this book. This MCQs book is unique in sense, that it provides lot of specific paediatric surgical knowledge directly in MCQs with short and to the point explanations.

Atlas gives classical features of disease in images that helps in spot diagnosis of disease. Little explanation about the image is given at side. Nearly all the paediatric surgical cases are gathered at one place.

In most of the clinical examination discussion starts from apparent finding, in this regards, this atlas greatly helps in spot diagnosis of the cases. MCQs help in passing theoretical examination.

This book is beneficial for all paediatric Surgery examination, general surgical examination to cover portion of pediatric surgery and pediatric medicine examination to cover differential diagnosis of surgical conditions. This Atlas also gives an idea to general practitioner about clinical spot diagnosis of paediatric surgical cases and medical students about awareness of paediatric surgical conditions

• Language: English
• Publisher: Partridge Publishing Singapore
• Release date: Dec 19, 2018
• ISBN: 9781543748697

Dr. Muhammad Khalid Syed

Dr Muhammad Khalid Syed is a consultant Pediatric Surgeon, in King Fahad Hospital, Al-Baha, Saudi Arabia. He is a Fellow of the College of Physicians and Surgeons Pakistan (FCPS, Paediatric surgery); a Member of the Royal College of Surgeons (MRCS), Edinburgh, United Kingdom; a Fellow of the European Board of Paediatric Surgery (FEBPS); and a Fellow of the American College of Surgeons (FACS). He has special interest in neonatal surgery and is always keen in teaching and training of junior doctors He has written this MCQs book and collected images to help aspiring doctors to pass paediatric surgical examinations and other examinations to cover portion of paediatric surgery.

Book preview

Copyright © 2019 Dr. Muhammad Khalid Syed. All rights reserved.

ISBN

978-1-5437-4868-0 (sc)

978-1-5437-4869-7 (e)

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

Atlas of Paediatric Surgery with MCQs

The only book with combination of Colour Atlas of Paediatric surgery with MCQs in Paediatric surgery.

This provides you key information and helps in spot diagnosis of Paediatric surgical cases.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

www.partridgepublishing.com/singapore

12/18/2018

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DEDICATION

This book is dedicated to the

Holy Prophet MUHAMMAD (Peace be upon him), whose teaching enlightened the world and has given glorious vision to humanity.

Dr Muhammad Khalid Syed

CONTENTS

Dedication

List of contributors in images

Preface

Section 1   Abdomen A

Section 2   Abdomen B

Section 3   Abdomen C

Section 4   Urology A

Section 5   Urology B

Section 6   Thoracic Surgery

Section 7   Head and Neck

Section 8   Soft Tissue Lesions, Limbs and Spine

Multiple Choice Questions in Paediatric Surgery

ABDOMEN A

ABDOMEN B

ABDOMEN C

UROLOGY A

UROLOGY B

THORACIC SURGERY

HEAD AND NECK AND SOFT TISSUE LESIONS

ORTHOPEDIC

TRAUMA

ONCOLOGY

VESSELS AND LYMPHATICS

ANATOMY FOR PAEDIATRIC SURGEONS

LIST OF CONTRIBUTORS IN IMAGES

1. Dr. Ahmad Abduh AlFaqeeh, Consultant paediatric surgeon at Al-Qunfudah General Hospital, Al-Qunfudhah, Saudi Arabia

2. Dr. Shahid, Specialist pediatric surgeon, Biljurashi, Saudi Arabia

3. Dr. Muhammad Amjad Chaudhry, Consultant paediatric surgeon, Pakistan institute of medical sciences Islamabad, Pakistan

4. Dr. Alsayed Mohammad Alsayed Othman,MD, Lecturer of pediatric surgery. Dept of Surgery, Div. of Pediatric Surgery, Faculty of Medicine, Al-Azhar university. Assuit , Egypt. He, at present works in King Fahad Hospital, Al Baha, Saudi Arabia.

5. Dr. Muhammad Umar Nisar, Pakistan institute of medical sciences, Islamabad, Pakistan.

6. Dr.Tarek Ahmed Mohammed Ali , Consultant plastic surgeon, King Fahad Hospital, Al Baha, Saudi Arabia

7. Mr. Mohammed Rabie khattab Consultant pediatric surgeon, king Fahad hospital, Al-Baha, Saudi Arabia

8. Dr. Ijaz Hussain , Consultant paediatric urologist, Al Shifa international hospital, Islamabad, Pakistan

9. Prof. Ahmed Abdelghaffar Helal MD, Assistant Professor of Pediatric Surgery, Pediatric Surgery Department, Faculty of Medicine, Al-Azhar University. Cairo, Egypt.

10. Dr. Mohammad Alsayed DAboos, MD,Lecturer of Pediatric Surgery. Pediatric Surgery Department, Faculty of Medicine, Al-Azhar university. Cairo, Egypt.

11. Dr. Mohamed Yousef Batikhe, MD, Lecturer of pediatric surgery. Dept. of Surgery, Div. of Pediatric Surgery , Faculty of Medicine, Sohag university. Sohag, Egypt.

12. Mahmoud abd elhady abo hewag, MS, Assistant lecturer of pediatric surgery, Dept. of Surgery, Div. of Pediatric Surgery, Faculty of Medicine, Al-Azhar university. Assuit , Egypt.

13. Ahmed Abdelghaffar Helal, MD, Assistant Professor of Pediatric Surgery, Pediatric Surgery Department, Faculty of Medicine, Al-Azhar University. Cairo, Egypt.

Special thanks to

Dr. Hasan Othman Al Zendi Al Ghamdi

Chief of surgical department

King Fahad Hospital, Al Baha, Saudi Arabia.

PREFACE

This book is the first book with combination of colour Atlas and MCQs in Paediatric surgery. No such combination is available in market.

In colour Atlas patient’s photos, X-rays, CT scan and MRI can be seen. Among patient’s photos there are pre-operative and per-operative photos, as well as photos of complications. Name of the disease and finding on image has been mentioned. Atlas has eight section, the topics covered are abdomen, urology, thoracic surgery, head, neck, soft tissue lesions, limbs and spine.

It contains about 300 images most of these are from King Fahad Hospitals Al- Baha, Saudi Arabia, after taking written consent. Rests of images are from different other hospitals. I tried to remove identity of patient’s, as much as possible to maintain the privacy. Contributor names are mentioned in contributors list.

My last book that last published few months ago MCQs in Paediatric surgery also has been merged in this book. This MCQs book is unique in sense that lot of specific pediatric surgical knowledge is provided directly in MCQs with short and to the point explanations. MCQs are more than 500 in number divided in 12 sections; last section of MCQs is related to concerned anatomy. The topics covered are abdomen, urology, thoracic surgery, trauma, head, neck, soft tissue lesions, limbs, spine, orthopedic and oncology.

Most of MCQs are made from back ground knowledge of following books.

Pediatric Surgery. 4th edition (2 volume set). Edited by Kenneth J. Welch, Judson G. Randolph, Mark M. Ravich, James A. O’Neill, Jr., and Marc I. Rowe, Chicago: Year Book Medical, 1986.

Rob & Smith’s Operative Surgery: Pediatric Surgery. 5th edition. By L. Spitz and A.G. Coran. Boca Raton: CRC Press, 1998.

Pediatric Surgery Secrets. 1st edition. By Philip L. Glick, Richard Pearl, Michael S. Irish, and Michael G. Caty. Hanley & Belfus, Philadelphia: 2000.

Last’s Anatomy: Regional and Applied. 12th edition. By Chummy S. Sinnatamby. Churchill Livingstone, London: 2011.

This book has been reviewed by

Dr. Ahmad Abduh AlFaqeeh, consultant paediatric surgeon at Al-Qunfudah General Hospital, Al-Qunfudhah, Saudi Arabia.

Dr. Shahid, specialist pediatric surgeon, Biljurashi, Saudi Arabia.

Dr.Abdul Raouf Goraya General Surgeon ,Al-Aqiq General Hospital, KSA

Atlas gives classical features of disease that helps in spot diagnosis. All the paediatric surgical cases are gathered at one place. In most of the clinical examination discussion starts from apparent finding, if the candidate cannot pick up the apparent finding, all rest of reply and discussion becomes useless. In this regards, this atlas greatly helps in spot diagnosis of the cases.

MCQs help in passing theoretical examination.

This book is beneficial for, all Paediatric Surgery examination, general surgical examination to cover portion of Paediatric surgery and Paediatric medicine examination to cover differential diagnosis of surgical conditions. This Atlas also gives an idea to general practitioner about clinical spot diagnosis of Paediatric surgical cases and medical students about awareness of Paediatric surgical conditions.

Dr. Muhammad Khalid Syed

MBBS, FCPS, MRCS, FEBPS, FACS

SECTION 1

ABDOMEN A

1. Pyloric stenosis

2. Pyloric atresia

3. Duodenal atresia

4. Jejunal atresia

5. Ileal atresia

6. Pseudomecomium cyst

7. Intussusception

8. Meckel’s diverticulum

9. Patent Vitellointestinal duct

10. Omphalocele (Exomphalos)

11. Gastroschiasis

12. Mid gut volvulus and gangrene

13. Trichobezoar

14. Foreign body ingestion

15. Aerophagia

16. Fibroid polyp at distal ileum

17. Malrotation

18. Gastroesophageal reflux

19. Mesenteric cyst

20. Intestinal parasites

21. Stepladder sign in intestinal obstruction

Fig. 1A

Pyloric stenosis

Four weeks old baby with nonbilious projectile vomiting since 7 days.

X-Rays show dilated stomach and paucity of gas in rest of abdomen.

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Fig. 1B

Pyloric stenosis

Pyloromyotomy

It is a standard operation for pyloric stenosis.

Hypertrophied muscle is cut along the whole length until the mucosa bulges out.

Per-operative image shows mucosa visible pyloric mucosa.

There are different ways of doing procedure e.g. epigastric incision, supraumbilical incision or by laparoscopy.

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Fig. 2A

Pyloric atresia

Pyloric atresia, X-Rays showing single bubble sign.

History of polyhydramnios and a dilated stomach, Presented with nonbilious vomiting after each feed.

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Fig. 2B

Pyloric atresia

Newborn, contrast study showing no contrast going out of stomach in pyloric atresia.

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Fig. 2C

Pyloric atresia

Epidermolysis bullosa, this child has associated pyloric atresia.

Congenital pyloric atresia (CPA) is very rare and usually seen as an isolated anomaly, which has an excellent prognosis. Once it is associated with Epidermolysis bullosa, it has poor prognosis.

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Fig. 2D

Pyloric atresia

Pyloric atresia, per-operative image. This is type II.

There are three anatomical types of pyloric atresia.

Type 1 – Pyloric membrane (57%)

Type 2 – Pyloric tissue replaced by solid tissue (34%)

Type 3 – Atretic pylorus with a gap between stomach and duodenum (9%)

Picture6.jpg

Fig. 3A

Duodenal atresia

X- Rays showing double bubble sign, a feature of duodenal atresia.

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Fig. 3B

Duodenal atresia

Duodenal atresia with upper limb anomalies (left deficient radius and carpal bone. Right forearm deficient bones).

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Fig. 3C

Duodenal atresia

Same patient, duodenal atresia associated with annular pancreas. Second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas.

This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines.

Picture9.jpg

Fig. 3D

Duodenal atresia

2nd pateient

X-Rays shows double bubble sign.

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Fig. 3E

Duodenal atresia

Same, 2nd patient

Contrast study shows contrast not going beyond 1st part of duodenum.

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Fig. 3F

Duodenal atresia

Same, 2nd patient

Delayed X-Rays film shows, contrast passing through perforation in atretic web?

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Fig. 4A

Jejunal atresia

Two days old baby presented with upper abdominal distension and bilious vomiting.

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Fig. 4B

Jejunal atresia

Plain film showing Jejunal atresia

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Fig. 4C

Jejunal atresia

Jejunal atresia, X rays shows dilated stomach, duodenum and proximal jejunum.

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Fig. 4D

Jejunal atresia

Same patient. Triple bubble sign in Jejunal atresia

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Fig. 4E

Jejunal atresia

Oral contrast showing Jejunal atresia

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Fig. 4F

Jejunal atresia

Jejunal atresia, difference between size of caliber between proximal and distal segment.

Picture18.jpg

Fig. 4G

Jejunal atresia

Still dilated proximal jejunum, 40th post operative day for the Jejunal atresia (Primary anastomosis). Anastomosis is working but very slowly.

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Fig. 4H

Jejunal atresia

Other view, same patient.

Dilated proximal jejunum (40th post operative day to primary anastomosis for the Jejunal atresia).

Contrast is going slowly across the anastomosis.

Picture20.jpg

Fig. 4I

Jejunal atresia

Jejunal atresia, X rays shows dilated stomach, duodenum and proximal jejunum.

Picture15.jpg

Fig. 4J

Jejunal atresia

This looks type II, but on further search other atresia also found. There are 5 types of Jejunal atresia:

Type I consists of a membrane completely occluding the lumen with the intestine intact.

Type II is a gap in the intestine with a fibrous cord between the proximal and distal segments of intestine.

Type IIIA is a mesenteric gap without any connection between the segments.

Type IIIB is Jejunal atresia, the distal small bowel is coiled like an apple peel, and the gut is short.

Type IV consists of multiple Atretic segments (resembling a string of sausages).

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Fig. 4K

Jejunal atresia

Per-operative view of Jejunal atresia showing proximal dilated and distal narrow intestine.

Picture23.tif

Fig. 4L

Jejunal atresia

Proximal dilated part is tapered over tube using GIA stapler.

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Fig. 4M

Jejunal atresia

Patency of distal intestine is checked by inflation with saline.

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Fig. 4N

Jejunal atresia

Associated type I Atresia at Recto- sigmoid area in patient with Jejunal atresia.

Managed by longitudinal opening, excision of web and transverse closure.

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Fig. 4O

Jejunal atresia

Same patient, additional Jejunal atresia. Case of multiple Jejunal atresia with atresia at recto-sigmoid area.

Picture27.tif

Fig. 4P

Jejunal atresia

Multiple Jejunoileal Atresia (Type IV).

Picture28.jpg

Fig. 4Q

Jejunal atresia

Multiple Jejunoileal Atresia, after resection.

Picture29.jpg

Fig. 4R

Jejunal atresia

Jejunal atresia, anastomosis has started working after 10 days. Contrast is going across the anastomosis.

Picture30.jpg

Fig. 5A

Ileal atresia

Ileal atresia. X-Rays shows, multiple air fluid levels. No gas in colon.

Picture31.jpg

Fig. 5B

Ileal atresia

Ileal atresia, gastrografin enema shows unused colon.

Picture32.jpg

Fig. 5C

Ileal atresia

Appreciate difference in caliber between proximal ileum end and beyond atresia.

Picture33.jpg

Fig. 5D

Ileal atresia

Type III.

Shows gap in the mesentery.

Picture34.jpg

Fig. 5E

Ileal atresia

Fibrous band and internal hernia, in the same patient with Ileal atresia. Per-operative features in this patient were congenital bands, internal hernia, malrotation, volvulus and type III atresia.

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Fig. 5F

Ileal atresia

Volvulus with malrotation, in the same patient with Ileal atresia.

Picture36.jpg

Fig. 5G

Ileal atresia

Fibrous band from caecum to subhepatic area, in the same patient with Ileal atresia.

Picture37.jpg

Fig. 5H

Ileal atresia

Other patient, with Type II Ileal atresia, two ends are connected by fibrous band.

Picture38.jpg

Fig. 6A

Pseudomecomium cyst

New born with abdominal distension, bilious vomiting and vague huge abdominal mass, looks to be extending from right upper abdomen.

The differential diagnosis includes duplication cysts, mesenteric cyst, choledochal cysts and meconium pseudocyst.

Picture39.jpg

Fig. 6B

Pseudomecomium cyst

Pseudomecomium cyst. Per- operative, thick peal of meconium after evacuation of meconium.

Per-operative finding, giant meconium pseudocyst secondary to ileum perforation.

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Fig. 7A

Intussusception

Ultrasound showing sandwich sign.

Picture41.jpg

Fig. 7B

Intussusception

Ultrasound showing donut sign.

Picture42.jpg

Fig. 7C

Intussusception

Ultrasound showing sandwich and donut sign.

Picture43.jpg

Fig. 7D

Intussusception

Intussusception, during reduction by gastrografin shows Cobra head sign.

8 months old baby having intussusception up to descending colon, reduction stopped at this point, and failed, later on operation was done successfully, manual reduction done.

Picture44.jpg

Fig. 7E

Intussusception

Same patient, reduction fail. The goal was to reduce the intussusception by exerting pressure on the apex of the intussusceptum to push it from the pathologic position into the original position.

Picture45.jpg

Fig. 7F

Intussusception

Another patient.

Per-operative image shows Ileocaecal Intussusception.

Picture46.tif

Fig. 7F

Intussusception

Another patient.

Per-operative image shows hyperemic and edematous last part of