1. Dr. Hatem ELGohary
Lecturer of General Surgery
Helwan University

2. Thermoregulation
less subcutaneous fat – wide surface area – immature peripheral
vasomotor mechanisms.
Action:
Warm IV fluids – Warm theater – Insulate child

3. Gastro-oesophegeal Reflux and Aspiration
Action: Naso-gastric tube
Infection Immature immune system
Action: Antiseptic conditions – proper Antibiotics.
Clotting disorders
Action: Preoperative intramuscular vit. K

4.  Gentle.
 In Warm Theater.
 Under Antiseptic condition.
 Bipolar Diathermy.
 Absorbable fine sutures.

5. Causes

6. Arrested along its normal pathway
of descent.

7. typically present in the scrotum in early
infancy;
it can be manipulated into the bottom of the
scrotum without tension but tends to be pulled
up by the cremaster
muscle. With time, the testis resides
permanently in the scrotum;
however, follow-up is advisable as, rarely, the
testis subsequently
ascends into the inguinal canal.

8. lies outside its normal line of descent, most
often in the perineum or femoral
triangle. An undescended testis may be
palpable in the groin or at the neck of the
scrotum or it may be impalpable if absent or
located in the abdomen or inguinal canal.

9. Investigations

10.  Ultrasound inguinal and femoral region
 Laparoscopy
 Hormonal in bilateral impalpable testis to
detect testosterone rise after IM HCG

11. Risk

12. Fertility. To optimise spermatogenesis the
testis needs to be in the scrotum below body
temperature at a young age.
Malignancy. Undescended testes are
histologically abnormal
and at an increased risk of malignancy.
Cosmetic and psychological. In an older boy a
prosthetic testis
can be inserted to replace an absent one.

13. Treatment

14. Orchidopexy is usually undertaken as a day-case
procedure. The
testis is mobilised through an inguinal incision, preserving the vas
deferens and testicular vessels. The associated patent processus
vaginalis is ligated and divided and the testis is placed in a
subdartos scrotal pouch.
Orchidectomy is often unilateral intra-abdominal testis,
which cannot be corrected by
orchidopexy because of the future risk of malignancy. In cases of
bilateral intra-abdominal testes, microvascular transfer and
staged orchidopexy are two options available to preserve the
testes if the testicular vessels are too short to permit a single-
stage orchidopexy.

17. Acquired disorder, hypertrophy of the circular
muscle layer increases the length and diameter
of the pylorus.
More in Boys between 2 to 8 weeks.

18. Symptoms:
Non billious vomiting at the end of the feed.
Signs:
.Visible gastric peristalsis from left to right.
.Olive-tumour felt in the epigastrium to the
right hypochondrium.
U/S: shows the thickened pyloric muscle.

19. 1. Rehydration
2. Correction of electrolytes imbalance
3. Ramstedt’s pyloromyotomy