identifying and treating abdominal lump in children

www.drvivekrege.com 9821052680/9869268680

Abdominal Lump in childrenAbdominal Lump in children

Dr. Vivek M. RegePediatric Surgeon & Pediatric Urologist

Bhatia Hospital

Saifee Hospital

Fortis Hospitals


Abdominal Mass in a ChildAbdominal Mass in a ChildAcute PresentationAcute Presentation

• Detailed historyDetailed history• Proper examinationProper examination• Relevant Relevant

investigationsinvestigations• Specific TherapySpecific Therapy

Chronic PresentationChronic Presentation• Discovered accidentallyDiscovered accidentally• Long standing historyLong standing history• Proper examinationProper examination• Relevant inv.Relevant inv.• Specific TherapySpecific Therapy

Lump in abdomenLump in abdomen• Ignore the lump – may be temporaryIgnore the lump – may be temporary

• Try homeopathy, naturopathy etc…Try homeopathy, naturopathy etc…

• Try home made medicine for gas etc..Try home made medicine for gas etc..

• Why worry if there is no pain or any Why worry if there is no pain or any symptom?symptom?

• Finally go to family doctor or pediatrician Finally go to family doctor or pediatrician as it is increasing or new symptoms are as it is increasing or new symptoms are coming upcoming up


LumpLump

• What is being treated?What is being treated?

• What is the origin of this lump?What is the origin of this lump?

• What can this lump be?What can this lump be?

• Can a child have cancer???Can a child have cancer???

• How do I find out the answers?How do I find out the answers?

• Who is the best person to consult??Who is the best person to consult??


Children with LumpsChildren with Lumps

• All are children I have operated uponAll are children I have operated upon• Many have come after 3 months of detectionMany have come after 3 months of detection• These are only These are only somesome of the children I have of the children I have

treatedtreated• Some have come years after detectionSome have come years after detection• Cancers can and do occur in childrenCancers can and do occur in children• Cancers can be treated if detected and treated Cancers can be treated if detected and treated

in time in time



UltrasonographyUltrasonography• Solid or Cystic massSolid or Cystic mass

• Organ of origin – Kidney, Intestines, Liver, Organ of origin – Kidney, Intestines, Liver, bladderbladder

• Dimensions of the mass – how big/small etcDimensions of the mass – how big/small etc

• Local extension in adjoining structures Local extension in adjoining structures

• Infiltration in major abdominal vessels – Aorta, Infiltration in major abdominal vessels – Aorta, IVCIVC

• Further investigations - specificFurther investigations - specific

www.drvivekrege.com 9821052680/9869268680Operated by: Dr. Vivek RegeOperated by: Dr. Vivek Rege

Large lump on left side abdomen


Imaging

Solid mass from the kidneySolid mass from the kidney


CT Scan Abdomen


WILMS TUMOUR –RAJ. SURGERY


WILMS TUMOUR - CT SCANWILMS TUMOUR - CT SCAN

Therapy for CancerTherapy for Cancer

• Early diagnosisEarly diagnosis

• Multi disciplinary approachMulti disciplinary approach

• Surgery if possible to remove tumourSurgery if possible to remove tumour

• Chemotherapy : anti cancer drugsChemotherapy : anti cancer drugs

• Radiation therapy in some tumorsRadiation therapy in some tumors

• Regular follow up to look for recurrenceRegular follow up to look for recurrence



Lump seen & felt in right flank 4 month oldLump seen & felt in right flank 4 month old

USG Cystic massUSG Cystic mass


HYDRONEPHROSIS

Hydronephrosis due to obstruction at the

pelvi - ureteric junction leading to

dilated pelvicalyceal system, thinning of

the parenchyma and hold up of urine

leading to recurrent urinary infection and back pressure effects

Pelvis

Parenchyma

Ureter


HYDRONEPHROSIS – P.U.J. OBSTR.HYDRONEPHROSIS – P.U.J. OBSTR.


Principal of surgery


Huge abdominal lump in 6 year old Cystic(USG), arising from left kidney


CT Scan - Hydronephrosis


Pelvi Ureteric Junction Obstruction with Hydronephrosis

Pelvis

Kid

ney ti

ssue

Ureter


Large size of Functionless Kidney on Left side

KKiiddnneeyy

PelvisPelvis


NEUROBLASTOMA


NeuroblastomaNeuroblastoma


RhabdomyosarcomaRhabdomyosarcoma

TumorTumor


3 months old child with visible peristalsis going left to right – epigastric region and a palpable lump in

the abdomen


Hypertrophic pylorus


Transverse incison taken & abdomen opened, Transverse incison taken & abdomen opened, stomach – pyloric tumour delivered outstomach – pyloric tumour delivered out

PylorusPylorus


PyloromyotomyPyloromyotomy

Cut through all Cut through all layers of serosa layers of serosa and muscles but and muscles but keep mucosa intactkeep mucosa intact


Mucosa


Barely visible scar 3 months later


Pain in abdomen with vomiting, lump- RIF Pain in abdomen with vomiting, lump- RIF Flexion deformity of the right hip seen Flexion deformity of the right hip seen

Possibilities: Appendicular / Psoas abscessPossibilities: Appendicular / Psoas abscess


USG – Free thick fluid and peritoneal mass.Pus in the peritoneal cavity; omentum

in RIF


Dirty, inflammed, infected adherent Appendix with twist

Tip


Appendix


ABDOMINAL LUMP


Large dumbell mesenteric cyst in proximal jejunum

Jejunum


Resected Specimen of Cyst and Jejunum


CT Scan – Pelvic lump - boy


Large pelvic colon cyst in mesentery


Abdominal LymphomaAbdominal Lymphoma


Abdominal Lymphoma Abdominal Lymphoma


CT Scan Abdomen - LymphomaCT Scan Abdomen - Lymphoma

www.drvivekrege.com 9821052680/9869268680IntussusceptionIntussusception


INTUSSUSCEPTION

Proximal

Distal


Appendicular lumen


BARIUM ENEMA REDUCTION

Proximal bowel

Distal colon



Partial reduction


Free flow of Barium into

small bowel – confirms a complete

reduction of the Intussusception


INTUSSUSCEPTIONINTUSSUSCEPTION

Ileum

Caecum

Intussusception


Intussusception -reduced Intussusception -reduced

Gangrenous bowel

www.drvivekrege.com 9821052680/9869268680Intussusception seen clearlyIntussusception seen clearly


Ileo Cecal valve seen after reductionIleo Cecal valve seen after reduction

www.drvivekrege.com 9821052680/9869268680Mass in the abdomen Left lower quadrantMass in the abdomen Left lower quadrant


Intussuscepted mass delivered into incisionIntussuscepted mass delivered into incision


The edge of the intussusceptum seenThe edge of the intussusceptum seen


Intussusception being manually reducedIntussusception being manually reduced


Intussusception prolapsing Intussusception prolapsing out of the rectumout of the rectum

www.drvivekrege.com 9821052680/9869268680Round worm mass in the intestineRound worm mass in the intestine

www.drvivekrege.com 9821052680/9869268680Resected loop with round wormsResected loop with round worms


ANTENATAL ABDOMINAL MASS

Mass

Stomach


Tumour


Hemangioendoth.Hemangioendoth.

Right liver Right liver lobelobe


INFANT POST OPERATIVELY

SPECIMEN CUT OPEN


Choledochal CystCholedochal Cyst MRCP - Gall bladderMRCP - Gall bladder


Large Choledochal cyst with gall bladder seen

Cyst

G B Liver


Cyst opened and the communication with CBD seen proximally


Hepato -jejunostomy anastomosis


CystCyst


Prenatal Diagnosis – Abdominal CystAbdominal Cyst


Ovarian TumourOvarian Tumour

Solid mass in the OvarySolid mass in the Ovary


Cystic mass newborn Cystic mass newborn


Imperforate hymen with accumulation of Imperforate hymen with accumulation of blood in the uterus & vaginal cavitiesblood in the uterus & vaginal cavities


Imperforate Hymen – older girl Imperforate Hymen – older girl

Take Home MessageTake Home Message• Do not ignore a lump in a childDo not ignore a lump in a child

• Do not take therapy without knowing what Do not take therapy without knowing what you are dealing with - ask…..you are dealing with - ask…..

• Consult a specialist to find out moreConsult a specialist to find out more

• Do not try to self diagnose by Google…Do not try to self diagnose by Google…

• Earlier the diagnosis faster the correction Earlier the diagnosis faster the correction can occurcan occur

• Take a second opinion if any doubtTake a second opinion if any doubt


identifying and treating abdominal lump in children

Health & Medicine

childrenabdominal lump

children cancers

childabdominal mass

kidneysolid mass

vivek rege large lump

imaging solid mass

bladderorgan of origin

major abdominal vessels