Pediatric Surgery Conditions This is a sample of some of the common conditions we treat in Connecticut Children’s Pediatric Surgery Division. AbscessAn abscess is a pocket of pus under the skin. Most abscesses are caused by an infection that develops in a cut or wound. It is made up of pus and white blood cells that the body sends to fight the infection. Abscesses can develop anywhere on the skin, deeper inside the skin or in a tooth. Children are more likely to get an abscess when they don’t properly clean or care for their cuts. What are the signs and symptoms of an abscess? Common symptoms of an abscess include: An area on the skin that looks like a pimple and may leak fluid Skin that is red or swollen A bump on the skin that may be painful or tender Fever and chills (from the infection) What causes an abscess? Most abscesses are caused when an infection develops in a cut or wound. In some cases, they can be caused when a foreign body, like dirt or a hair, gets caught in a cut. How are abscesses treated? Treatment for abscesses can vary based on how severe the infection is, and may include surgical or non-surgical options. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an abscess. Surgical Sometimes surgery is needed to drain the pus from a large abscess. Non-Surgical Antibiotic medicines can treat the infection. The doctor may drain the pus from the abscess by making a small cut in it. Anorectal malformationsAn anorectal malformation occurs when the anus or rectum don’t develop properly before birth. Anorectal malformations can cause a problem with passing stool from the body. The anus may be missing, blocked by a layer of skin or be narrower than normal. If the anus is completely blocked, it is called imperforate anus. Less often, the rectum may be blocked or narrow. The child may also have an abnormal passage (called a fistula) from the rectum to another part of the body, such as the urinary tract or the vagina. Children with anorectal malformations may also be born with birth defects in other parts of the body. What are the signs and symptoms of anorectal malformations? Anorectal malformations are often found shortly after birth. Common signs include: No visible anus or a membrane over the anus An anus in a location that is not normal Not passing any stool in the first 24 hours after birth Passing stool through the fistula and out of the vagina, urethra or perineum (the area between the anus and genitals) What causes anorectal malformations? Anorectal malformations occur while a baby is developing during pregnancy. In most cases, experts don’t know what causes anorectal malformations. In rare cases, the condition may run in families. Children with certain genetic syndromes may also be more likely to have an anorectal malformation. How are anorectal malformations treated? Anorectal malformations are treated with surgery. The specific type of surgery your child needs depends on the type of the malformation. Sometimes children need more than one surgery to repair the problem. Connecticut Children’s team of surgeons will create an individual treatment plan for your child based on their condition. Whenever possible, we use laparoscopic surgical techniques using small incisions. AppendicitisAppendicitis is the inflammation of the appendix, a small organ attached to the large intestine. The appendix is located in the lower right area of the stomach. Appendicitis is most common in children and young adults ages 10 to 30, but it can occur in people of all ages. Appendicitis is an emergency condition that needs immediate care. If appendicitis is not treated, the appendix can burst. This can cause severe health complications. What are the signs and symptoms of appendicitis? The most common symptom of appendicitis is pain in the stomach. This pain may: Start suddenly Begin in the area around the belly button and move to the lower right side of the stomach Be severe enough to wake your child if they are sleeping Feel worse when your child moves, coughs or takes a deep breath Other symptoms of appendicitis can include: Fever Nausea or vomiting Loss of appetite Swelling in the stomach Please note there are many conditions that can cause stomach pain. If your child has these symptoms, it’s important to see your doctor for proper diagnosis and treatment. What causes appendicitis? Appendicitis can have several causes. Inflamed tissue in the wall of appendix caused by an infection A blockage in the appendix Inflammatory bowel disease In some cases, the cause of appendicitis is not known. How is appendicitis treated? Appendicitis is treated by removing the appendix as soon as possible. This surgery is called an appendectomy. At Connecticut Children’s we perform laparoscopic surgery whenever possible to remove the appendix. This type of surgery uses small incisions and a thin tube with a video camera at the end, called a laparoscope, to see inside the stomach. The surgeon then uses small tools to remove the appendix. BurnsBurns are an injury caused by heat. The heat can come from a variety of sources, such as thermal, chemical, electrical or radiation. Studies show most burns in children happen by accident at home. Burns are classified by how severe they are. First-degree burns are the most minor type of burn. They only affect the top layer of skin. Second-degree burns are more serious burns. They affect both the top layer of skin and some of the layer below it. Third-degree burns are the most severe type of burns. They affect all layers of the skin. What are the signs and symptoms of burns? The symptoms of burns can vary depending on the type of burn and how severe they are. Symptoms of first-degree burns include: Redness Minor pain and swelling Symptoms of second-degree burns include: Blisters Peeling skin More severe pain Symptoms of third-degree burns include: Whitish or yellowish look to skin Dry look to skin What causes burns? Some common causes of burns in children include sunburn, scalding liquids, flames from fireplaces or lighters, or spilled or swallowed chemicals. How are burns treated? Treatment for burns will depend on the type of burn and how severe it is. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for a burn. Surgical Some second-degree and most third-degree burns may need skin grafts to repair the skin. Non-Surgical Most first- and second-degree burns can be treated at home with various types of first aid. Chronic abdominal painChronic abdominal pain is any type of pain in the stomach area that lasts for more than two weeks. It is a common condition in children, especially between the ages of 5 to 10. The pain may be constant or it may come and go over time. In a small number of cases, the child has a medical condition that is causing the pain, such as heartburn or Crohn’s disease. In most cases, doctors are not able to link the pain to any medical condition. This is called functional abdominal pain. But this doesn’t mean the pain is not real. The pain may keep children from school or out of other activities. What are the signs and symptoms of chronic abdominal pain? The symptoms of chronic abdominal pain can vary. Symptoms may include: Feeling of pain or burning in stomach area Bloating or fullness Loss of appetite Nausea or vomiting Diarrhea or constipation In many cases, your child may not be able to describe the pain or tell you where it is located. Please note there are many conditions that can cause similar symptoms. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes chronic abdominal pain? In some cases, an underlying medical condition is the cause of the pain. But more often, the pain is triggered by something else. Possible causes include: Stress or anxiety A need for attention Irritable bowel syndrome A nervous system that is more sensitive to pain How is chronic abdominal pain treated? In many cases, the pain gets better on its own after time. If treatment is needed, your child’s doctor may recommend one or more of the following. Surgical If your child has a medical condition that is causing the pain, such as Crohn’s disease, they may need surgery. At Connecticut Children’s, our surgeons are skilled in using minimally invasive (laparoscopic) techniques to perform surgery on children and teens with all types of abdominal conditions. Non-Surgical Behavioral therapy Relaxation exercises Medicines to relax the muscles or to ease anxiety Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for chronic abdominal pain. Gastroesophageal reflux disease (GERD)Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back up into the esophagus, the tube that connects the mouth and the stomach. It is a more serious and chronic type of gastroesophageal reflux (GER), which is common in babies and sometimes occurs in older children. But not all children with GER have GERD. Babies and children with GERD have symptoms that occur often or don’t go away. Over time, GERD can lead to another condition, called Barrett’s esophagus. This is when the lining of the esophagus becomes damaged from constant exposure to stomach acid. What are the signs and symptoms of GERD? The symptoms of GERD in babies and children include: Heartburn (in older children) Symptoms of asthma (in children under 12) Trouble swallowing (in children under 12) Frequent coughing, gagging or choking Stomach pain Burping Not eating Wheezing Bad breath A sour taste in the mouth Please note there are many conditions with symptoms similar to GERD. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes GERD? GERD is often caused by a problem with the lower esophageal sphincter (LES). This is a muscle at the end of the esophagus. The LES opens to let food into the stomach and closes to keep food inside the stomach. When the LES does not close properly, stomach acid can flow back up into the esophagus. This causes heartburn and the other symptoms of GERD. Babies often have a weak LES. Some foods can make the LES remain open longer than it should. These include: Peppermint Chocolate Fatty foods Some other things that can cause GERD include: Taking certain medicines Secondhand smoke Being obese How is GERD treated? The options to treat GERD may depend on your child’s symptoms and how severe the condition is. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for GERD. Surgical A surgery, called a Nissen fundoplication, can reduce symptoms of GERD. During the surgery, the surgeon wraps the top part of the stomach around the esophagus to tighten the LES. At Connecticut Children’s, it is often done as laparoscopic surgery. This type of surgery uses small incisions and a thin tube with a video camera at the end, called a laparoscope, to see inside the esophagus. Non-Surgical In some cases, making lifestyle or diet changes can reduce the symptoms of GERD. These may include limiting foods that can cause GERD, eating smaller portions and not lying down after eating. Medicines can help reduce the amount of stomach acid or help the stomach empty faster, which can reduce symptoms. GastroschisisGastroschisis occurs when a baby’s intestines grow outside of the baby’s body, through an opening in the stomach wall. It is a condition that occurs while a baby is developing. The opening most often develops on the right side of the baby’s belly button. It can vary in size. If it is large, other organs may also grow outside of the body. Because the intestines are not covered with skin, they are exposed to amniotic fluid. This can make them irritated or swollen. What are the signs and symptoms of gastroschisis? Gastroschisis may be found on an ultrasound before the baby is born. After the baby’s birth, the opening in the stomach wall is easily visible. What causes gastroschisis? Gastroschisis develops early in pregnancy. Experts do not know exactly what causes the condition, but it is more common in mothers under age 20. In some cases, it may be linked to environmental factors, medicines the mother takes during pregnancy, or what she eats or drinks. How is gastroschisis treated? Gastroschisis needs to be treated with surgery shortly after birth. If the opening is small, your baby may need only one surgery. If the opening is larger, and there are many organs outside of the body, the surgery may need to be done in stages. Whatever your baby’s surgical needs, you can rest assured that our surgical team at Connecticut Children’s have years of experience in caring for children with gastroschisis, as well as other types of congenital anomalies. HemorrhoidsHemorrhoids are swollen veins in the anal area. They can be inside the anus (internal) or around the outside of the anus (external). What are the signs and symptoms of hemorrhoids? Common symptoms of hemorrhoids include: Pain or irritation around the anus Itching around the anus Swelling or a lump around the anus Bright red spots of blood in stool or in the toilet or on toilet paper after a bowel movement What causes hemorrhoids? Hemorrhoids are most often caused by straining during bowel movements. They can also be caused by chronic constipation or diarrhea. How are hemorrhoids treated? Hemorrhoid treatment is based on how severe the hemorrhoids are. Your child’s treatment may include surgical or non-surgical options. Surgical Surgery to remove the hemorrhoids may be needed if other treatments don’t work. At Connecticut Children’s, our experienced surgeons use minimally invasive techniques whenever possible. Non-surgical Using creams or suppositories to reduce the swelling of hemorrhoids Sitting in a warm water bath Using ice packs to reduce swelling Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for hemorrhoids. Hirschsprung DiseaseHirschsprung disease is a rare disease that a baby is born with. It occurs when some or all the nerves in the large intestine (colon) are missing. These nerves help move stool through the colon and out of the body. When they are missing, stool can get backed up inside the colon. This can cause the colon to become blocked and can lead to infection, swelling and pain. What are the signs and symptoms of Hirschsprung disease? The symptoms of Hirschsprung disease can vary depending on how severe the condition is. Babies with severe disease usually have symptoms shortly after birth. These may include: No bowel movement in the first 48 hours after birth Green or brown vomit A swollen belly Babies with less severe disease may have symptoms that develop over time: Constipation A swollen belly Delayed growth Loss of appetite What causes Hirschsprung disease? Hirschsprung disease develops during pregnancy. Experts don’t know exactly what causes it. How is Hirschsprung disease treated? Hirschsprung disease is usually treated with a surgery called a pull-through procedure. In this surgery, the surgeon removes the part of the colon that is missing nerve cells. If possible, they connect the healthy part to the anal opening. At Connecticut Children’s, our surgeons most often perform this surgery in one step using minimally invasive (laparoscopic) techniques. Some children need to have the surgery in two stages. If this is this case, the child first has ostomy surgery. During this surgery, the surgeon removes the diseased part of the colon. Then they attach the healthy end of the colon to an opening made in the belly called a stoma. The stool passes through the stoma and into a bag the child wears outside the body. The bag needs to be emptied several times a day. Once the colon has healed, the surgeon connects it to the anus during a second surgery and sews the stoma closed. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for Hirschsprung disease. Inflammatory bowel disease (IBD)Inflammatory bowel disease is a chronic inflammation of the digestive tract. It can be diagnosed at any age. There are two main types of IBD: Crohn’s disease can occur in any part of the digestive tract, from the mouth to the anus. However, it often appears only in certain areas, skipping over some parts of the digestive tract. Crohn’s disease causes inflammation in the entire thickness of the intestinal wall. Ulcerative colitis occurs only in the large intestine (colon) and rectum. It affects only the first layer of the intestinal wall, rather than the entire thickness. It can be hard to tell the difference between the two types of IBD. What are the signs and symptoms of irritable bowel disease? The symptoms of IBD in children include: Stomach pain Diarrhea Blood in the stool Frequent bowel movements Weight loss Fever Fatigue Joint pain The symptoms of IBD may come and go. Sometimes children can go for a long time — months or even years — without having any symptoms. Please note there are many conditions with symptoms similar to IBD. It’s important to see your child’s doctor for proper diagnosis and treatment. What causes IBD? Experts don’t know exactly what causes IBD, but it seems to be a combination of genetics, the immune system and environmental factors. IBD can run in families. How is irritable bowel disease treated? The options to treat IBD may depend on your child’s symptoms and how severe the condition is. Your child’s doctor may recommend surgery if the condition cannot be treated by medicine alone. Surgical Surgery for Crohn’s disease may help relieve symptoms. But it is not a cure. Crohn’s disease can come back after surgery and affect another part of the digestive tract. Surgery for ulcerative colitis involves removing the colon (colectomy). The surgeon then creates a pouch from the small intestine (J-pouch) in place of the rectum. At Connecticut Children’s, our surgeons are skilled in using minimally invasive (laparoscopic) techniques to perform surgery on children and teens with IBD. Non-surgical Medicines can help reduce inflammation and the risk for infection. Dietary therapy can help ensure that children get the nutrition they need to grow. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for IBD. Ingrown toenailsAn ingrown toenail is when the corner of a toenail grows into the skin next to it. It usually occurs when the nail is cut too short, and the skin grows over the nail. It happens most often in the big toe. Ingrown toenails can become painful, swollen and infected. What are the signs and symptoms of ingrown toenails? Common symptoms of ingrown toenails include: Pain in the toe Redness or swelling around the edge of the nail If your child has any of the following symptoms, the nail may be infected: Pus or discharge from the area A bad smell A feeling of warmth in the area What causes ingrown toenails? Ingrown toenails are most often caused by cutting the nail too short. Other causes can include: Ripping the nail instead of cutting it, or cutting it in a rounded shape Wearing shoes that are too tight Using the toe for a repeated activity, such as kicking a ball How are ingrown toenails treated? In many cases, the ingrown toenail can be treated at home by soaking the foot in a warm saltwater bath a few times a day. But if the toenail becomes infected, you may need to visit your child’s doctor for treatment. Surgical Sometimes surgery is needed to remove a section of the nail or the whole nail. Non-surgical Antibiotic medicines may help if the toe is infected. The doctor may remove the corner of the nail and drain the pus from the area. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an ingrown toenail. Labial adhesionsLabial adhesions are when the inner lips of the vulva become stuck together. This can completely or partially cover the vaginal opening. Labial adhesions are most common in girls ages 3 months to 6 years, before puberty begins. What are the signs and symptoms of labial adhesions? Most children with labial adhesions have no symptoms. When symptoms do occur, they may include: Pain, irritation or itching around the vagina Frequent urinary tract infections Leaking or dribbling urine after urinating What causes labial adhesions? Experts think the low levels of estrogen in the body before puberty may play a role in causing labial adhesions. Other causes may include: Fecal soiling Irritation from diaper rash or soaps How are labial adhesions treated? If there are no symptoms, labial adhesions may not need any treatment. In many cases, the adhesions become unstuck during puberty, when the body starts making estrogen. If treatment is needed, your child’s doctor will discuss treatment options with you. Surgical In rare cases, surgery may be needed if the adhesion is very thick and will not separate using topical cream. Our expert team of surgeons at Connecticut Children’s have specialized training in the gynecological needs of girls and young women of all ages. Non-surgical Your child’s doctor may prescribe estrogen cream or other types of cream to help separate the adhesion. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for labial adhesions. Ovarian and uterine massesOvarian and uterine masses include any type of growth that develops in the ovaries or uterus. The ovaries and uterus are parts of the reproductive system in girls and women. Ovarian and uterine masses are rare in children, but possible masses can include: Ovarian tumors, which may be non-cancerous or cancerous Ovarian cysts Uterine fibroids What are the signs and symptoms of ovarian and uterine masses? These symptoms may vary, depending on the type of mass, but can include: Pain in the stomach or pelvic area Heavy menstrual bleeding Frequent urination A feeling of fullness in the stomach Nausea and vomiting Low back pain What causes ovarian and uterine masses? Experts do not know the cause of many types of ovarian and uterine masses. How are ovarian and uterine masses treated? Treatment for ovarian or uterine masses depends on the type of mass. In some cases, your child’s doctor may recommend watching the mass over time to see if it needs treatment. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an ovarian or uterine mass. Surgical Some masses, such as cancerous tumors and fibroids, may need to be removed with surgery. At Connecticut Children’s, our surgeons use minimally invasive options as often as possible to reduce bleeding and recovery time. Non-Surgical Some masses, such as uterine fibroids or ovarian cysts, may be treated with medicines. Ovarian cystsOvarian cysts are small sacs filled with fluid or blood that grow on or in an ovary. The ovaries are part of the female reproductive system. Ovarian cysts can grow on one or both ovaries. They are common in girls and women of all ages. What are the signs and symptoms of ovarian cysts? In many cases, these cysts do not have any symptoms and they go away on their own with no problems. If larger cysts develop, they may cause: Pelvic pain Bloating or a feeling of fullness in the lower stomach area Irregular periods If a cyst bursts, it is an emergency and can cause the following symptoms: Nausea and vomiting Severe pelvic pain Passing out In rare cases, cysts can also cause ovarian torsion, twisting the ovary. This is also an emergency and causes the same type of symptoms as a burst cyst. What causes ovarian cysts? Most ovarian cysts develop due to changing levels of hormones in the menstrual cycle. How are ovarian cysts treated? Many ovarian cysts go away on their own and do not need any treatment. Or the doctor may choose to monitor the cyst over time. If your child’s cysts do need treatment, your doctor may discuss surgical or non-surgical options. Surgical If a cyst is especially large or does not go away, it may need to be removed by surgery. Emergency surgery may be needed if the cyst has burst or has caused ovarian torsion. Non-surgical Hormonal medicine, such as birth control pills, can help prevent more cysts from growing The cyst may be drained if it is very large to prevent ovarian torsion. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for ovarian cysts. Pectus excavatumPectus excavatum is a deformity in the chest wall that gives the chest a sunken look. It happens because of a problem with the way the cartilage in the breastbone (sternum) and ribs develop. The condition is usually diagnosed by the time a child is age 1 and is more common in boys than in girls. Pectus excavatum can range from mild to severe. What are the signs and symptoms of pectus excavatum? In most cases, the chest will have a slight to moderate sunken appearance. This may become more noticeable as the child grows. In many cases, your child may not have any other symptoms, especially if the condition is mild. Symptoms in children with a more severe condition may include: Shortness of breath, especially with exercise Chest pain What causes pectus excavatum? Experts do not know what causes pectus excavatum. In some cases, it may run in families. How is pectus excavatum treated? Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for pectus excavatum. Some children with very mild cases may not need treatment. For children who do need treatment, surgery to correct the condition is the only option. There are a few surgical options to treat pectus excavatum. At Connecticut Children’s, our surgeons most often use the Nuss procedure, a minimally invasive approach. During the procedure, the surgeon uses small incisions to insert a metal bar under the breastbone. This bar lifts and corrects the shape of the breastbone over time. Usually, the bar stays in the chest for about two years. Umbilical herniaAn umbilical hernia is a bulge you can feel or see on your child’s belly button. It develops when part of the intestine pushes through the muscle in the stomach wall. In most cases, the hernia does not cause any pain. In rare cases, the intestines can get caught inside the hernia. This is called an incarcerated hernia and it can cause severe pain. This condition needs to be treated right away. Umbilical hernias are common in children. They are more common in children born prematurely. What are the signs and symptoms of an umbilical hernia? A swelling or bulge in the belly button area The bulge may get larger if the child is crying Redness or pain at the bulge (incarcerated hernia) What causes an umbilical hernia? As a baby develops during pregnancy, the umbilical cord passes through a small opening in the muscles of the baby’s stomach wall to connect with the mother. Usually, this opening closes on its own after birth. When it doesn’t close properly, it can cause an umbilical hernia to form. How is an umbilical hernia treated? Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an umbilical hernia. In many cases, the umbilical hernia will close on its own by the time a child is 3 or 4 years old. If the hernia does not close, your child may need surgery to repair the hernia. At Connecticut Children’s, this surgery is often done as an outpatient procedure so your child can go home the same day. During hernia repair surgery, your child is put under general anesthesia. The surgeon will make a small incision at the bottom of the belly button. The surgeon then pushes any intestine back inside the muscle wall and repairs the opening with stiches to prevent another hernia.