The most frequent cases when parents ask for the medical attendance of a pediatric surgeon are infants’ congenital omphalocele, small children’s femoral hernia originating from the weakness of abdominal wall and small boys’ disorders of foreskin or testicles. Beyond these problems there may be a number of smaller or bigger deviations (node, skin outgrowth) on the children, which may also call for a specialist. Our clinic’s pediatric surgical counseling provides the facilities of simpler interventions, follow-up the development and the proposed treatment of the detected deviations and also the coordination with the parents to decide about an operation if necessary.
When do we have to see definitely the pediatric surgeon?
All cases necessitate the specialist’s counseling in which parents recognize sensitivity of any of the child’s body regions, he suffers from pain or there are painless but previously not discovered nodes, skin outgrowths, moist or dry deviations (e.g. fistula), larger tinted birth marks or other type of full-grown skin lesions.
We also have to ask for the medical attendance of the pediatric surgeon if we notice problems with the belly button, foreskin, testicles or in the pubes at infant or childhood age.
Disorders of the belly button
Omphalocele (umbilical hernia), which is a balloon like protrusion of the child’s belly button having a size from a few millimeters up to 2-3 cm, is usually a congenital childhood disorder. Around the age of 2-3 years in most cases the hernia gap closes itself without any intervention – fortunately omphalocele rarely brings forth complaints in this life period. If the child is over 3 years and omphalocele still exists then a surgical solution may be required since without this intervention on longer term umbilical hernia may become larger and depending on the position of the small bowels it could result in intestinal torpidity or bowel obstruction.
Besides we also have to see a pediatric surgeon if:
- we recognize that after the falling off the baby’s umbilical cord stump there is a discharging red bump in the navel (belly button)
or at any age we observe a water-clear discharge from belly button
When boys’ foreskin cannot be fully retracted over the glans penis we can speak about phimosis. It is important to know that in infancy foreskin is sealed to the glans and not retractable so this condition at this age is normal and later it will be settled itself or with assistance. This complaint does not require operation.
But true phimosis could be terminated by surgery only. Among the causes of this problem there could be an injury due to the early (forced) retraction trials, a scar, frequent inflammation or other skin diseases. If we do not pay sufficient attention to this condition it may effect adolescent or later the adult age as well. Its consequences are: purulent inflammation of foreskin sack, infection of the urinary tract, difficulties in urination, impaction of the foreskin in behind the glans penis due to forced retraction, painful erection, and psychological problems.
So we have to ask for the medical advice of the specialist if the child’s foreskin is tight or its cellular fusion to the glans penis could be observed (or in case of a girl a similar condition could be recognized between her labia)
Clinical aspects which require surgical counseling related to the testicles
1./ Retractile testicle, disorders of testicles’ descent, undescended testicle (cryptorchidism)
Testicles develop in the baby boy’s abdomen and descend into the scrotum shortly before birth. If this process – due to any reason – is disorientated, testicles cannot descend into the scrotum in the normal way and time. In some rare cases it may happen in infancy that testicles already descended into the scrotum move back. If in the first year of life testicles descend for good then there is a good chance that this disorder will not make further problems. However permanent undescended testicles are associated with reduced adult fertility (cells producing sperm may have damages), with an increased chance for testicular torsion or with trauma which may lead to the development of malignant tumors. (In addition to these hiatus of testicle my cause psychological problems as well.)
So it is important to see the pediatric surgeon if we cannot always feel the testicles in the scrotum.
When overstraining it may happen that a few centimeter sized bulge appears in the groin which could be easily pushed back – this disorder is called femoral hernia. In such cases an internal organ, most likely an intestine or for girls the ovary, bulges through a gap (hernia gate) on the abdominal wall. It is most common on the right side but it may be developed on the left or both sides of the body. One of the causes of its emergence is the weakness and underdevelopment of the abdominal wall, especially at premature babies. It may also develop owing to the increase of the intra-abdominal pressure (e.g. obstipation, coughing). Another cause of this disease at boys may be the persistency of a so-called hernial sac which interconnects with the abdominal cavity and took shape during the descent of the testicles. The most serious complication of femoral hernia is the incarceration when the narrow hernia gate strangulates the internal organ slipped out to the hernia sac. This may cause, by blocking the blood supply to part of the intestine, a bowel wall necrosis or perforation on the strangled section. Owing to these conditions finally a peritonitis (inflammation of the thin layer tissue inside the abdomen) may develop which is often a life-threatening disease.
That’s why it is very important to have the pediatric surgeon examine the child having the suspicion of hernia. Femoral hernia could be always corrected by operation.
We also have to consult with the pediatric surgeon if our child has articulation (logopedic) disorders due to the short lingual frenulum (tongue web).
Facing one of the above mentioned disorders parents, in the course of our pediatric surgical counseling, could receive an individual approach to clarify in which cases the operation is really necessary, what the ideal time for the intervention is, what the operational process is like, how long the hospital rehabilitation and the complete recovery takes. Smaller operations may be executed in the course of our ambulant consultation.