Pediatric Surgery — MCQs

Q: A 9-month-old child presents with excessive cry and presentation shown below. On examination right iliac fossa sausage shaped lump is felt. What is the best treatment?

IVF- Antibiotic-Air enema. ***IVF- Antibiotic-Air enema*** - The clinical picture (9-month-old with excessive cry, **"currant jelly" stool** (image), and a **right iliac fossa sausage-shaped lump**) is classic for **intussusception**. - Initial management involves **resuscitation** (IV fluids), **antibiotics** to prevent sepsis from bowel ischemia, and then an **air enema** for both diagnosis and non-surgical reduction. - Air enema has a **success rate of 70-90%** for uncomplicated cases and is the **first-line treatment**. *IVF- Antibiotic- NG tube* - While IVF and antibiotics are appropriate initial steps for an ill child with presumed intussusception, an **NG tube** alone is insufficient for treating the intussusception itself. - An NG tube is primarily used for **gastric decompression** in cases of bowel obstruction, which may be a complication of intussusception, but it does not resolve the invagination. *IVF-Antibiotics- Barium enema* - A **barium enema** can also be used for reduction, but an **air enema** is generally preferred due to a **lower risk of peritoneal contamination** if perforation occurs and better visualization under fluoroscopy. - While it has diagnostic and therapeutic potential, air enema is often considered safer and equally effective. *IVF- Antibiotics-Warm saline enema* - This option lacks the specific pressure-based mechanism required to reduce an intussusception effectively. - A **warm saline enema** is a general type of enema, but it does not provide the controlled pressure needed for hydrostatic or pneumatic reduction of intussusception. *IVF- Antibiotics- Laparotomy* - **Laparotomy** (surgical reduction) is reserved for cases where **pneumatic reduction fails**, **signs of peritonitis** are present, or there is **suspected bowel perforation**. - Initial management should always attempt non-surgical reduction first unless contraindications exist (free air, hemodynamic instability, peritonitis).

Q: The structure shown in the image on the left represents which of the following?

Ventriculoperitoneal shunt. ***Correct: Ventriculoperitoneal shunt*** - The image on the left clearly depicts a **ventriculoperitoneal (VP) shunt**, showing the catheter originating from the lateral ventricle in the head and ending in the **peritoneal cavity** (represented by the abdominal area) - VP shunts are the **most common type** of shunt used for treating hydrocephalus in children - They drain excess **cerebrospinal fluid (CSF)** from the brain's ventricles to the peritoneal cavity where it can be absorbed - The purpose is to **relieve elevated intracranial pressure** caused by hydrocephalus *Incorrect: Ventriculoatrial shunt* - A VA shunt is shown in the image on the **right**, not the left - VA shunts terminate in the **right atrium of the heart**, not the peritoneal cavity - The left image clearly shows termination in the abdominal cavity, not the chest *Incorrect: Ventriculopleural shunt* - A ventriculopleural shunt would drain CSF into the **pleural space** around the lungs - The image shows drainage to the **abdomen**, not the thoracic cavity - This is a less common alternative when VP shunting is not feasible *Incorrect: Lumboperitoneal shunt* - A lumboperitoneal shunt originates from the **lumbar subarachnoid space** in the lower back, not from the ventricles in the head - The image clearly shows the catheter originating from the **cranium/head**, indicating a ventricular origin *Incorrect: External ventricular drain* - An external ventricular drain (EVD) is a **temporary** system that drains CSF externally into a collection bag - The image shows an **internalized, permanent** shunt system with subcutaneous tubing - EVDs are used for short-term management, not long-term treatment like the shunt depicted

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