Phimosis Doctor in Kolkata

Consult Paediatric Surgeon if your Child has :

Swollen Scrotum :

If painful then think of Torsion testes or Epididymorchitis or Obstructed hernia. These are all surgical emergency and should consult Paediatric Surgeon immediately. If swelling is not painful then it may due to Hydrocele or Insect bite.

Absent testes in scrotum :

It is a case of Undescended testes, which needs surgical correction. It is a wrong belief that testes will come down with age.

Pain Abdomen :

If your child is having pain abdomen, consult Paediatric Surgeon to rule out causes like appendicitis, mesenteric lymphadenopathy, constipation etc. Child with classical appendicitis will have pain abdomen which has shifted from umbilical region to right side of abdomen, vomiting and fever. If child is having only pain abdomen with no vomiting and fever, it can be cured by medication without the need for surgery. So always consult Pediatric Surgeon at the earliest, if your child is having pain abdomen. If your child is having constipation then also he will be having pain abdomen after feeds.

Umbilical Discharge :

If your baby is having discharge from the umbilicus after falling of umbilical stump, consult Paediatric Surgeon to rule out patent Vitello-Intestinal Duct (VID) or patent Urachus. Sometimes discharge may be due to infection at the umbilicus which needs dressing with antibiotics. If neglected, it causes Umbilical Granuloma which will need excision by diathermy.

Umbilical Hernia :

If there is swelling at the umbilicus, when baby cries then it is a case of umbilical hernia. If the hernia is reducible it needs no emergency surgical intervention but should be under follow up of a Paediatric Surgeon. Do not ever strap the umbilicus with coin. If the hernia gets obstructed or the hernia is increasing in size then it needs surgical repair.

Vomiting :

Bilious i.e. greenish vomit is always surgical unless proved otherwise. Consult Paediatric Surgeon immediately. Bilious vomiting is due to intestinal obstruction. If your baby is having projectile non-bilious vomiting i.e. vomits milk then think of Infantile Hypertrophic Pyloric Stenosis in which there is obstruction at the gastric outlet due to hypertrophy of muscle at the pylorus. So, it needs splitting of the hypertrophied muscle i.e. Ramsted’s operation. If your child is not gaining weight and having frequent episode of non-bilious vomiting then should consult Paediatric Surgeon to rule out Malrotation.

Bleeding Per Rectum :

Most common cause of bleeding per rectum is Rectal Polyp which needs polypectomy i.e. removal of polyp. If your child is crying due to pain abdomen with vomiting and distension of abdomen, always consult Paediatric surgeon to rule out Intussusception, in which one portion of bowel goes inside the lumen of bowel and causes intestinal obstruction. If it is not detected early then child may pass red currant jelly like stool. If Intussuseption is detected early then it can be reduced manually or else the bowel will become gangrenous and will need resection of the gangrenous part of the bowel and anastomosis of the healthy portion. Intussusception is often misdiagnosed as a case of bacillary dysentery.

Constipation :

If your child does not pass motion daily then it may be due to either Habitual Constipation or Hirschprung’s Disease. Do not neglect constipation as it is difficult to cure if you start the treatment late.

Failure To Gain Weight, Urinary Infection or Difficulty In Passing Urine :

Always consult Paediatric Surgeon if your child has urinary tract infection and rule out surgical causes of urinary tract infection. Child needs to be investigated to rule out Posterior Urethral Valve (PUV), Vesico-Ureteric Reflux (VUR) etc.

Abnormal Urethral Opening and Bending of Penis :

It is a case of Hypospadias and you should consult Paediatric Surgeon as soon as you detect this abnormality as surgical correction has to be done before the age of 2 years. CIRCUMCISION should not be done if there is Hypospadias as this prepucial skin is used for the repair of hypospadias. If your female child is having single opening i.e. common opening for urethra and vagina then it is a case of Urogenital Sinus (UGS).

Not able to retract the prepuce :

Consult a Paediatric Surgeon if you notice ballooning of prepuce while passing urine. It may be a case of physiological adhesion of prepuce. Do not intervene if child is asymptomatic. If symptomatic then either do prepucial adhesiolysis in stages by gently retracting the prepuce. If it fails then it needs Prepucioplasty in which the constricting ring is cut. Here the prepucial skin is preserved. Do not get unnecessary circumcision done which is very painful unless it is a ritual circumcision. Circumcision is required only if prepucial skin has become white i.e. Balanitis Xerotica Obliterans (BXO).

Bedwetting :

If your child bed wets only at night then it needs behavioural therapy and medicines. If your child wets his undergarments in daytime also then rule out surgical causes of incontinence of urine like ectopic ureter etc and neurogenic bladder.

Absent Anal Opening or Any Abnormality :

If your baby is having absent anal opening or you notice that your child is passing motion from an abnormal opening then your child is having Ano-Rectal Malformation (ARM). Anal opening may be anteriorly placed or in case of female she may be passing from vaginal opening.

Ambiguous Genitalia :

If you notice any abnormality in the genitalia of your child consult Paediatric Surgeon immediately. It may me small penis or enlarged clitoris or bifid scrotum or herpigmentation of labia majora or absent testes in scrotum or urethral opening in peno-scrotal region. Your child may be suffering from Disorders of Sexual Development. Do not name the child unless you prove it that it is male or female child.

Disharge from small opening in neck :

Consult Paediatric Surgeon and rule out Branchial Sinus.

Any swelling over body :

If you notice any swellings anywhere in body then consult Paediatric Surgeon. It may be lipoma, dermoid cyst, cystic hygroma, thyroglossal cyst, enlarged lymph node, tumor or abscess.

Any Trauma or Injury :

Consult Paediatric Surgeon if your child gets injured to rule out injury to internal organs and for repair of the lacerated cut injury.

Respiratory distress and recurrent chest infection :

Always get a Chest X-ray done and rule out Eventration Diaphragm or Congenital Diaphragmatic Hernia. Consult a Paediatric Surgeon for surgical repair.

Inguinal Hernia / Hydrocele :

The passage between the baby’s belly and groin is open. In medical terms it is called patency of processes vaginalis. So, if the opening of the passage is big, then intestine comes out from baby’s belly which is called hernia and if the opening is small then only fluid comes out from baby’s belly and causes hydrocele.

Since the opening of passage is small hence hydrocele may resolve by 2 years so you can wait for 2 years and be under supervision of a Paediatric Surgeon. If the child has developed hernia it will not resolve as the size of opening of the passage is large enough for the intestine to come out and will require surgery at the earliest to close the opening of the passage. Name of the surgery is Herniotomy which is same for both hydrocele and hernia. Chances of hernia getting obstructed is higher in a child as the passage is like an bottle neck i.e. if anything gets inside the bottle it is very difficult to take out from inside, as the neck of bottle is narrow, hence surgery i.e. herniotomy should be done at the earliest.

Herniotomy can be done as a Day Care surgery i.e. child can be discharged the same day or at the most next day, if they stay far away from hospital. Laparoscopic repair has not much role in herniotomy in a child except in a female child as herniotomy is done through a small incision in the groin crease which is invisible later and child can be discharged the same day. For Laparoscopy you have to make 3 incisions i.e. one for the camera and two for the working instruments and child cannot be discharged the same day. Incidence of hernia developing on both sides is more in female child so in female, laparoscopy has a role as you can repair the hernia on the opposite side in the same sitting.

Undescended Testes :

It means testes has not descended to its normal location in scrotum i.e. scrotum is empty. Consult Paediatric Surgeon if it does not descend by 6 months.

Surgery i.e. orchidopexy should be done between 6 months to 2 years i.e. as early as possible, to preserve testicular function, to prevent torsion and to reduce the risk of trauma. Orchidopexy can be done as a Day Care surgery i.e. child can be discharged the same day or at the most next day, if they stay far away from hospital. If the testis is palpable in the groin, laparoscopy has no role. Laparoscopy has a role only in impalapable testes.

Posterior Urethral Valve (PUV) :

It is an obstructing membrane in the posterior urethra which causes obstruction to passage of urine leading to dilatation of ureter and kidney due to backflow of urine. 10-15% of these children lead to end stage renal failure in future requiring renal transplant in future. Child will strain during passage of urine and have poor stream of urine. Some children present with urinary infection. So if a child develops urinary infection consult Paediatric Surgeon and get investigated to know the cause of urinary infection. If posterior urethral valve is detected then the valve should be fulgurated as early as passible to prevent back pressure changes. Valve is fulgurated i.e. burned endoscopically.

Vesicoureteric Reflux (VUR) :

It is retrograde flow of urine from urinary bladder to ureter leading to urinary infection and kidney damage. Consult Paediatric Surgeon if child develops urinary infection with burning urine and increased frequency of urine or has fever without any apparent cause or failure to gain weight. Some may have gastrointestinal symptoms in urinary infection like anorexia, nausea and vomiting. If grade of VUR is less, low dose antibiotic is given till it spontaneously resolve. Surgery is required for high grade reflux or if urinary infection is recurring even when child is on antibiotic.

Hypospadias :

In this condition child is born with urethral opening on the undersurface of penis instead of at the tip. There is bending of penis downwards also. Consult Paediatric Surgeon as soon as you detect this abnormality as surgical correction has to be done before the age of 2 years. CIRCUMCISION should not be done if there is Hypospadias as this prepucial skin is used for the repair of hypospadias.

Hydronephrosis :

There is stretching or enlargement of kidney due to blockage of urine at the junction of kidney and ureter i.e. pelvi ureteric junction. It is diagnosed by ultrasonography for pain abdomen or urinary tract infection or any swelling noticed in the abdomen. Consult Paediatric Surgeon if hydronephrosis is detected on ultrasonography. It needs further investigation to know the nature of obstruction. If there is obstruction in DTPA scan or there is fall in relative function of kidney by 10% in 6 months or if there is palpable swelling then it needs surgical repair i.e. Pyeloplasty.