Case Presentation of Pediatric Surgery

1. Case Presentation of Pediatric Surgery Prepared by Dr. Ayman Abu-Obied Consultant of General & Laparoscopic Surgery European Gaza Hospital

2. 3 years male child, B. H. A • Referred from Pediatrician • Many hospitalizations due to pneumonias • Unexplained recurrent vomiting & cough • Chronic Abdominal Distention • Regular bowel habits

3. Child’s History • His Parents are first Cousins • Full term neonate, S. N. V. D • Apgar score 9 at 1st &5th min, Peripheral cyanosis • Admission to SCBU for 1 day for Observation • Passed meconium in the 1st day

4. Recurrent chest infections • Elective Bilat. Inguinal herniotomy in infancy • Emergent umbilical herniotomy at age of 2 years • Normal intellectual functions & development • He has a brother & sister with normal growth & development

5. On Examination: • Child looks well, alert • No signs of malnourishment • Normal developmental milestones • Weight & Height are within normal rates

6. Chest examination • Bilat. good chest expansion, no visible deformity • Palpation is within normal • Dullness at the base of Rt Hemithorax • Vesicular breathing Bilat. • Bowel sounds at base of Rt Hemithorax

7. Abdominal Examination • Mild abdominal distention • Transverse supraumb. Scar • Bilat. Inguinal scar • No organomegaly • Other body systems examination is within normal

8. Workup • Lab. Investigations are within normal limits • Chest x ray: • Hypodense round-shaped shadow in lower part of Rthemithorax • Absent gastric air bubble in the left subdiaphragmatic region

9. Barium meal: • Fundus of stomach is seen in the Rt side of chest cavity with high GOJ.

10. CT Scan: • Large hiatal hernia as stomach is seen at lower aspect of Rt hemithorax

12. Principle of Surgery • Reduction of the hernia. • Excision of the sac. • Approximation of Rt & left crura. • Antireflux fundoplication.

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