This document discusses two common pediatric surgical conditions: intussusception and acute appendicitis. Intussusception occurs when one portion of the intestine invaginates into an adjacent segment, causing obstruction. It is usually ileocolic and can progress to gangrene. Acute appendicitis is inflammation of the appendix due to obstruction, and risks include poor localization and early perforation in pediatrics. Both conditions present with abdominal pain and require resuscitation, antibiotics, and sometimes surgery. Other causes of abdominal pain discussed include intestinal obstruction, constipation, urinary issues, and gastroenteritis.

1. D R . H A T E M E L G O H A R Y
L E C T U R E R O F G E N E R A L S U R G E R Y
COMMON PEDIATRIC
SURGICAL CONDITIONS

2. INTUSSUSCEPTION
the invagination of one portion of the intestine
into an adjacent segment
causes a strangulating bowel obstruction, which can
progress to gangrene and perforation
Intussusception is classified according to the site of
the inner intussusceptum and outer intussuscipiens.
Most common is iliecolic.

4. AETIOLOGY
Causes:
• Hyperplasia of gut lymphoid tissue, which may in
turn be secondary to viral infection.
• Pathological lead point such as a Meckel’s
diverticulum, enteric duplication cyst or even small
bowel lymphoma.

5. DIAGNOSIS
Symptoms:
Colicky pain, vomiting.
Redcurrant jelly’ stool.
Signs:
Dehydration, abdominal distension and a palpable
sausage-shaped mass in the right upper quadrant.

6. DIAGNOSIS
Ultrasound:
Diagnosis can be confirmed by an abdominal
ultrasound scan (Target sign) or contrast enema.

7. MANAGEMENT
• Resuscitation with intravenous fluids, broad-
spectrum antibiotics and nasogastric drainage.
• Non-operative reduction of the intussusception
can be attempted using an air or barium enema.
• Successful reduction can only be accepted if there
is free reflux of barium or air into the small bowel,
together with resolution of symptoms and signs in
the patient.

8. • If non-operative reduction is contraindicated or
unsuccessful, surgery is necessary.
• Right-sided transverse abdominal incision the
intussusception is milked back by gentle
compression from its apex. Both the intussusceptum
and the intussuscipiens must be carefully inspected
for areas of non-viability.

9. ACUTE ABDOMEN

10. ACUTE APPENDICITIS
Inflammation of the vermiform appendix.
Causes:
Obstruction of the lumen of the appendix due to
lymphoid hyperplasia secondary to inflammatory
bowel disease, infections, foreign bodies, fecolith and
neoplasms.
Risk in pediatrics:
Poor localization of infection and early perforation.

11. DIAGNOSIS (MAINLY CLINICAL)
Symptoms:
• Abdominal pain in the right iliac fossa or
generalized in peritonitis.
• Vomiting.
• Loose stool.
Signs:
• Fever and tachycardia.
• Localized tenderness in the right iliac fossa.
• Guarding rigidity.

12. Investigations:
CBC: Leukocytosis and neutrophila.
CRP: High
U/S: Appendix, pelvic collection and to exclude other
causes of pain.

14. MANAGEMENT
• Rehydration.
• Broad spectrum Antibiotics.
• Analgesics.
• Appendectomy.
• IF Appendicular Mass  Interval Appendectomy
after 4- 6 weeks.
• If Appendicular Abscess  Drainage of abscess
then interval appendectomy 4-6 weeks.

15. OTHER CAUSES OF ABDOMINAL PAIN
• Intestinal obstruction. Consider intussusception,
inguinal hernia, adhesions and Meckel’s
diverticulum.
• Constipation. Often overdiagnosed as a cause of
acute abdominal pain, particularly as the plain
abdominal radiograph of a dehydrated ill child
frequently shows faecal loading.
• Constipation is more often a cause of acute
abdominal pain in a child who has been treated for
Hirschsprung’s disease or an anorectal
malformation.

16. OTHER CAUSES OF ABDOMINAL PAIN
• Urinary tract disorders. Urinary tract infection is a
cause of acute abdominal pain. Urinary symptoms,
fever and vomiting tend to predominate.
Urinalysis, microscopy and culture are useful. Boys with
pelviureteric junction obstruction can present with
acute or recurrent abdominal pain and no urinary
symptoms.

17. OTHER CAUSES OF ABDOMINAL PAIN
• Gastroenteritis. May cause colicky abdominal pain.
• testicular torsion.