Brought to you by the HFHT Choosing Wisely Committee...
Pediatric General Surgery
April 3, 2018
eConsult has widespread applications in all specialties, with just about every specialty represented in the OTN Physician Directory.

This week’s case comes from the realm of pediatric general surgery and while one would not think that a face-to-face consultation could be avoided with a surgical problem, this case was resolved online, with a high degree of satisfaction for the patient (and parent), the family doc and the consultant.

  • 1 year old male in for well check, and mom is concerned about his umbilical hernia. It is still sliding easily, but is fairly large (approximately 1.5cm).
Question: At what point should this patient be seen by paediatric surgery?


This consultation was provided by Dr. Jonathan Walton. Dr. Walton advises:

"When he is 3 years of age. We would rarely operate before this age for the following reasons: 80%+ go away on their own, they rarely cause trouble and we want to avoid an anesthetic under the age of 3 years (there has been recent concern in the literature about this).

Also the actual size of the hernia is less important than the fascial defect size. If I can fit my index finger through the fascial defect, then my sense is that it will eventually need fixing. Again, no need before the age of three.

Only exception maybe if the hernia is large and the kid is having a anesthetic for another reason and is 2 years of age."
We look forward to providing more examples of potential uses for eConsult in the coming weeks and look for dedicated space on the HFHT website for useful eConsult resources!
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