Your Child's Condition
1. Hernias and hydroceles
A swelling in the groin, which increases while crying or exertion and decreases after lying down is indicative of a hernia. A hernia denotes the presence of tummy contents like intestine, fluid etc coming out of the tummy into the groin via a potential passage.
A hernia may be present at birth or become evident thereafter.
A swelling predominantly in the scrotum, which remains relatively constant in size, is indicative of a hydrocele.
A hernia requires surgical correction (inguinal herniotomy) as early as possible. Failure to do so may result in obstruction of the herniated intestine and gangrene. A hydrocele is usually operated after 1.5 years of age since it has a potential for reduction on its own in the first 1.5 years of life. The surgical procedure is same for both.
Yes. It is usually done as a Day Care Surgery
2. Umbilical hernia
It is a bulge seen in the region of the bellybutton when the baby is crying, straining or coughing.
In pregnancy, the umbilical cord is connected to your baby’s abdominal muscles through a small hole. It usually closes on its own after the cord falls off following birth of the baby. When it doesn’t, the gap that’s left is an umbilical defect. If intestines and fluid poke through it, they cause your baby’s bellybutton to bulge or swell.
The hernia is clearly seen when the baby puts pressure on the abdomen while crying, straining or coughing. It usually goes back in when the baby is relaxed. A routine physical exam is enough to diagnose the problem. Your doctor will also measure the size of the defect which decides the further treatment
Smaller umbilical hernias don’t need any treatment. It usually closes on its own by 3 years of age. Only those hernias which have a large defect or which may not close on their own require surgery.
When the contents of the hernia cannot be pushed back and your baby develops symptoms like pain, vomiting, it is called an incarcerated umbilical hernia. This requires urgent surgery if it cannot be reduced.
The defect is repaired through a small curved incision taken on the lower rim of the belly button. The skin is then closed with absorbable sutures.
Yes. It is usually done as a Day Care Surgery
3. Undescended testis
The testes are normally housed in the scrotum. If the parents or the pediatrician notice an absence of one or both testes in scrotum, the child is usually referred to a pediatric surgeon.
If the testis can be felt in the groin, an open surgery is performed to bring it into the scrotum. If the testis cannot be felt, then a laparoscopic (endoscopic) surgery is done to see if the testis is present inside the tummy, whether it is of a normal size or small and to bring the testis to the scrotum in a single stage or two stages.
The surgery should be done at 6 months of age. This is because the testis start getting damaged if kept in an abnormal site for more than 6 months of life. The temperature in the scrotum is 2 degrees cooler than in the tummy, which maintains the testis in optimum condition.
Yes. It is usually done as a Day Care Surgery
4. Circumcision
It is a procedure in which the foreskin in boys is removed.
There are many conditions in which a circumcision may be needed like-
- Recurrent balanoposthitis (infection of the foreskin),
- phimosis(inability to retract the foreskin) which is not resolving with local treatment like a steroid cream etc
- recurrent urine tract infection
- Presence of a urological condition like vesicouretericreflux(VUR) or posterior urethral valves (PUV) or neurogenic bladder.
- Religious reasons
In children, it is preferable to perform circumcision under general anaesthesia.
There will be a small dressing, which will be removed one hour after surgery. The child needs to sit in a tub of lukewarm water 3 times a day for 10 mins each, after which pat the part dry and apply a generous dollop of prescribed ointment. The penis will swell up immediately after circumcision which will start reducing after 3 days and will reduce completely by the 7th day.
No, After circumcision, the foreskin will not grow back.
Yes. It is usually done as a Day Care Surgery
5. Tongue tie/Ankyloglossia
This is a condition in which the tongue is stuck to the floor of mouth by a membrane since birth.There are various degrees of severity.
A small procedure is performed to release the band which holds the tongue to the floor of mouth. No aftercare is required.
Yes. It is usually done as a Day Care Surgery
6. Abscess/infection
It is the collection of pus in a cavity anywhere in the body.
It requires removal of pus either by aspirating with a needle or making a cut over the abscess. This pus is sent for testing to check which organism has caused the infection to decide about which antibiotic is appropriate.
7. Hemangioma
Hemangiomas are small pink or red coloured tumors made up of small blood vessels. These are present at birth, increase in size till 1 year of age and then slowly reduce in size over 5 years.
Usually hemangiomas don’t require treatment, but if they are in places like face , groin, head, they may require some oral medication to be started. Hemangiomas require treatment if they grow rapidly or bleed or get infected. Treatment may be in form of oral medications, intralesional injections or removal (excision).
8. Lymphnode disorders
LYMPHNODE DISORDERS IN CHILDREN
The lump that is felt in the neck when your child has a cold or a sore throat are called lymph nodes. Lymph nodes are part of the body’s immune system. They help to destroy infectious germs, such as viruses and bacteria. Hence they get swollen in response to it. Frequently, children have enlarged lymph nodes.
Besides Head and neck, lymph nodes are also present in the armpit, groin, chest and the abdomen.
When lymph nodes are active in fighting infection, they may become swollen and painful. Usually, the pain is mild, and the lymph node does not get much bigger than 2 cms in size. It is also swollen in inflammatory conditions and malignancy like Hodgkin’s lymphoma.
Sometimes it needs no treatment at all, particularly if it is enlarged because it is fighting an infection. Occasionally, antibiotics will be prescribed.
Surgery (removal of the enlarged lymph node) is advised to rule out rarer causes if:
- Lymph nodes persist or increasing despite treatment for 2-3 weeks
- Enlarged nodes in absence of any clear cause
- Abnormal physical examination findings like enlarged liver and spleen
- Abnormal blood reports and chest x ray
Lymph nodes may become infected (Lymphadenitis) causing pain, swelling, redness. It usually responds to a course of antibiotics. Occasionally pus may get formed which requires a minor surgery to drain it.
9. Branchial cysts and sinuses
Branchial cleft cysts are due to trapped embryonic tissue in side of the neck.
It usually presents as a painless swelling on one side of the neck or as a sinus opening draining fluid. If it becomes infected, it presents as red painful swelling.
Physical examination is sufficient for diagnosis. Sometimes your doctor may recommend imaging like CT/MRI.
Surgery is the treatment of choice. It is done under general anaesthesia where in a small horizontal incision or at times two incisions are taken to remove the entire tract. Child is discharged the same day.
10. Thyroglossal cyst
A Thyroglossal duct cyst is a neck lump that develops from cells remaining after the formation of the thyroid gland (which is usually located in the lower part of the neck) in the embryo
It usually present as painless small lump in the front of the neck. If it is infected then it may become painful and red. Large swellings may cause difficulty in breathing. Very rarely it may present as small openings (sinus) in the neck which discharges fluid or sticky substance/mucus.
The diagnosis of the lump is made by a physical examination. Ultrasound may be recommended to see wether the lump is solid or filled with fluid, also to locate the thyroid gland. If the lump is solid that sometimes a thyroid scan is advised.
Surgery is the recommended treatment unless it is infected, in which case it is treated with antibiotics first. It is a day-care surgery done under General Anesthesia.The cyst with its attachment to the base of the tongue including a portion of the hyoid bone (horseshoe shaped bone in the front of the neck below the chin) is completely removed. Child is discharged the same day and called for follow up after 5 days to check for any wound infection.
11. Appendicitis
Appendicitis is inflammation of the appendix. This can be caused by an infection or blockage of the appendix. With a blockage, the appendix can become swollen and easily infected by bacteria. The swelling and infection can cause the appendix to rupture (burst). This results in peritonitis (infection inside the abdomen) or the formation of an abscess around the appendix.
Pain that starts near the belly button, then moves to the right side.
Fever.Vomiting. In a perforated/ruptured appendix these symptoms may be more diffuse and catastrophic.
The diagnosis of appendicitis can usually be made by examining your child and discussing their symptoms. Blood tests, an ultrasound or other investigations may be done if the diagnosis is less certain.
The best treatment of appendicitis is removal of the appendix. The operation may be done through a single incision over the appendix or by laparoscopy (‘key hole’ surgery). Antibiotics are given at the time of the operation to reduce the chance of infection.