Mr John Bowen FRCS(Paed) The Specialist Children’s Surgeon Your Child Matters
Mr John Bowen FRCS(Paed)The Specialist Children’s Surgeon Your Child Matters  

What sort of things do I treat?

What follows is by no means an exhaustive list of the conditions I am happy to advise on, so please do get in touch if there is something you are not sure about.

 

Groin Hernia or hydrocele

Probably the most common operation that I perform is an operation to repair an inguinal, or groin, hernia, or a hydrocele.

Hernias are very common in boys, especially when they are born prematurely; although less common in girls, it is not a surprise if I see young girls with a hernia too.

 

Sportman's groin 

This condition, which is unusual in children, occurs in active, sporty children ('Sportspeople'). It can cause pain that is severe enough to stop your child enjoying that sport, and can be quite difficult to diagnose. It is not a true 'hernia', and an operation, supported with careful return to activity, will usually fix the problem. 

 

Umbilical, or tummy-button, hernia

Many babies develop a swelling behind the tummy button, or umbilicus, that protrudes when they cry. In the first few weeks after the swelling first appears, it can enlarge very rapidly, and this may really worry you. Many have got better by 3 or 4 years of age

Umbilical hernias very rarely cause pain and I almost never see a child with a tummy button hernia that is causing emergency problems.


Circumcision (removing the foreskin)   
I usually circumcise boys because they have developed complications that might cause problems as they grow up. These complications are usually due to chronic infection, and include recurrent infections, a painful, bleeding foreskin or scarring that means I cannot pull the foreskin back when I examine your child.

The foreskin is naturally tight in babies and young boys, this is not a reason to have your son circumcised.

Sometimes I am asked to carry out a circumcision on a boy because of cultural or religious beliefs. In this case the foreskin is healthy, but the operation is the same otherwise. I would prefer not to do this operation until your son is out of nappies as there is a higher chance of complications when your son is a little younger.

 

Undescended testicles and other testicular problems

Often, what your Doctor thinks might be an undescended testicle is actually a ‘retractile’ testicle. This does not require an operation, and I will talk to you about this in clinic. In some cases, your son will have a true non-descended or undescended testicle. This would require an operation for a number of reasons.

There are a number of other, usually minor, problems that boys will complain of related to their testicles. I may need to organise scans to help understand the problem, and some of these problems may need an operation to sort them out. We will discuss this in detail when we meet, and as the investigations proceed.

 

Lumps and Bumps

Children develop lumps and bumps on and under the skin, all over their bodies. The more common places for lumps to appear are in the:
    skin itself
    neck
    armpit
    groin
    breast
    arms and legs

Do not worry, this will NOT be cancer, which is incredibly rare in children. I will thoroughly examine the lump and since most are quite distinctive, I am able to tell what the problem is very quickly.
These operations always need to be carried out thoroughly, as some of these lumps can grow back if not completely removed.


In-growing toenails (IGTN)

Children not infrequently develop in-growing toe-nails, which can be really painful and very difficult to treat. You will probably have seen a Podiatrist who will be struggling, because fiddling with a young persons nails can be painful, and your GP may well have given your child several courses of antibiotics, but with no lasting benefit.
There are a number of factors causing IGTN, including cutting (or chewing) nails too far back, footwear, gait and sports.

If we agree that an operation is going to help, I usually recommend a ‘wedge resection’ of the affected side of the nail. Occasionally I recommend an operation to remove the whole nail, to stop it growing back at all.


Abdominal pain

This is a very common symptom in children and can be a cause of immense anxiety; when the pains are frequent or severe some children will miss a lot of school.
In at least half of the children I see in clinic with recurring abdominal pains, no diagnosis is ever found and the symptoms eventually get better. I would then say your child has suffered from ‘non-specific abdominal pain’.

 

Non Specific Abdominal Pain/Irritable Bowel Syndrome

This is generally a diagnosis I use if I can find nothing abnormal to account for your child’s symptoms.

 

Constipation

This is very common in children of all ages and is often associated with painful bowel movements (poo-ing), that only occur every few days. There is often blood on the poo, or the toilet paper when your child wipes their bottom. I can sometimes see a small abnormality outside the back passage that helps me explain the symptoms.

I usually recommend generous doses of laxatives to make the poo soft and comfortable to poo out. I may advise that you give your child these medicines for many months, which will cause no harm.

It can be difficult to tell you why your child suffers from constipation but it almost always gets better within a few months of getting the treatment right.

 

Acute appendicitis

This is an emergency condition that causes severe abdominal pain. The nature of the pain is very often not at all typical, and varies a lot between different children. Your child may be vomiting, and won’t feel hungry. When I examine your child, I may find exquiste tenderness in the lower right hand corner of their tummy.

Sometimes it can be difficult to diagnose acute appendicitis, and blood tests and scans might be helpful. Even then, a diagnosis might be difficult, and I will then re-examine your child every few hours to watch for changing features.

 

Gall-stones, ulcers and indigestion

These are rare problems in children. To help make a diagnosis, I might organise blood tests, Xrays and scans; sometimes I will recommend an endoscopy (examination of the bowel with a flexible camera)

 

Endoscopy- Gastroscopy and colonoscopy

A lot of the children that I look after will require an endoscopy at some time. Examination of the gullet (oesophagus) and stomach is called gastroscopy, and examination of the large intestine (colon) is called colonoscopy. Both are usually carried out under general anaesthetic.

To make sure I can get good and clear views of the large intestine, which is normally full of poo, I will send you some medicine to take the night before your child’s examination. This is a very strong laxative and will give your child diarrhoea. I will make sure the instructions you need to understand this treatment come with the medicine. The next day, when I examine your child, there will be no poo to block my views!
    

Vomiting

Vomiting is a very common problem in childhood. Babies will often vomit frequently in the first few months of life (possetting). The vast majority of babies do grow out of this within 6 months or so.

There are many causes of vomiting. To help understand why your child is vomiting, I will ask a lot of questions, and examine your child. I may organise some blood tests, XRays and scans; endoscopy (examination with a flexible camera) may also help me.
Some of the problems I see are better looked after by a Paediatrician, or a Specialist Paediatric Gastro-enterologist (bowel specialist) and I will help you decide who I should refer you child to.


Pyloric stenosis

This is a relatively common problem in babies. It is caused by a thickening of the muscle that regulates how quickly your child’s stomach empties into the rest of the intestine. This thickening causes a blockage, meaning the stomach cannot empty, and your child therefore vomits his or her feeds back.

IIt is always necessary to treat pyloric stenosis with a small operation. This will be carried out after we have corrected your child’s dehydration with an intra-venous drip. The operation is never carried out as an emergency

 

Inflammatory bowel disease

Crohn’s disease and Ulcerative Colitis (UC) do occur in children, although these conditions are not as common as in adults. I recommend that your child is looked after by one of my Specialist Paediatric Gastro-enterolgy colleagues, although I work very closely with them if your child might require an operation as part of their treatment. There are many operations I might recommend, from removing diseased bowel, to operations to help your child take enough nutrition to fight their illness. We will meet to discuss this as frequently as is necessary to make the right decision, often with your child’s Consultant Paediatric Gastro-enterologist with us.

 

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