General and Thoracic Surgery - Referral Guidelines

The Division of General and Thoracic Surgery encompasses elective, trauma, and emergency surgery programs. Children’s National performs nearly 4,000 procedures each year on infants, children, and adolescents, including hernia repair and orchiopexy; biopsy; correction of neonatal surgical conditions; correction of biliary artresia; correction of portal hypertension; renal transplantation; intersex procedures; tumor procedures; procedures for disorders and abnormalities of the esophagus and trachea; correction of liver disorders; surgical treatment of burns; correction of congenital anomalities of the chest and abdomen; and laparoscopic, thorascopic, and laser procedures.

Children’s family-centered approach to caring for children has grown to become one of the most experienced and respected pediatric surgical programs in the world. Children’s team of pediatric general surgeons are joined by nurse practitioners and other healthcare professionals to deliver the highest quality and most technically advanced surgical care available for children.

The Division has many programs and clinics that offer children and families specialized care for their unique needs. Specialized programs include:


Cholelithiasis:

Right upper quadrant pain

Initial Work-Up:

  • Abdominal ultrasound

Referral When:

  • Any right upper quadrant pain with gallstones on ultrasound

Data Needed:

  • Clinic notes
  • Laboratory evaluation

Gastroesophageal Reflux:

Right upper quadrant pain

Initial Work-Up:

  • Medical and expectant management
  • Gastroenterology referral

Referral When:

  • Failure of medical management
  • Complicated GERD with respiratory symptom or infections
  • Growth failure
  • Esophagitis/Hiatal Hernia

Data Needed:

  • Clinic notes
  • Imaging studies
  • Endoscopy reports
  • pH probe results if available

Inflammatory Bowel Disease:

Crohns Disease, Ulcerative Colitis

Referral When:

  • Failure of medical management

Data Needed:

  • Clinic notes
  • Contrast studies
  • Current medication list

Inguinal Hernia/Hydrocele:

Initial Work-Up:

  • Physical exam
  • May require ER visit if incarceration suspected

Referral When:

  • Upon identification

Data Needed:

  • Clinic notes

Pectus Carinatum:

A protrusion of the chest wall. Can be asymptomatic or have symptoms such as chest pain or diminished exercise capacity.

Initial Work-Up:

  • Chest x-ray

Referral When:

  • Symptoms
  • Family education and options

Data Needed:

  • Clinic notes
  • Imaging studies
  • Cardiology and pulmonology notes if available

Pectus Excavatum:

A protrusion of the chest wall. Can be asymptomatic or have symptoms such as chest pain or diminished exercise capacity.

Initial Work-Up:

  • Chest x-ray

Referral When:

  • Symptoms
  • Family education and options

Data Needed:

  • Clinic notes
  • Imaging studies
  • Cardiology and pulmonology notes if available

Perianal/Perirectal Abscess:

Initial Work-Up:

  • Physical exam
  • Antibiotics
  • May need incision and drainage

Referral When:

  • Failure to heal
  • Recurrence

Data Needed:

  • Clinic notes

Pilonidal Cyst/Abscess:

Initial Work-Up:

  • Antibiotics
  • Personal hygiene
  • Perineal, sacral shaving
  • Keep area clean and dry
  • May require urgent drainage in emergency department

Referral When:

  • Upon identification

Data Needed:

  • Clinic notes

Splenomegaly/Hypersplenism:

Hereditary spherocytosis, Sickle Cell Anemia, Idiopathic Thrombocytopenia, Purpura

Initial Work-Up:

  • Hematology consultation
  • Abdominal ultrasound

Referral When:

For splenectomy to reduce

  • Symptoms
  • Transfusions
  • Thrombocytopenia

Data Needed:

  • Clinic notes
  • Ultrasound
  • Transfusion records
  • Hematologists consult

Umbilical Hernia:

Initial Work-Up:

  • Physical exam
  • If incarcerated (rare)
  • Send to emergency department

Referral When:

  • Persistent hernia in child
  • after 4-5 yrs of age
  • Large defect

Data Needed:

  • Clinic notes

Vascular Anomalies:

Hemangiomas/Lymphatic or Vascular Anomaliles

Initial Work-Up:

  • Ultrasound

Referral When:

  • For further management and advice, contact Children’s Vascular Anomalies Clinic at 202-476-2151.

Data Needed:

  • Clinic notes
  • Any imaging studies


Download a pdf of these guidelines. 

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"Through the ups and downs and the uncertainty of what was to come, I asked questions. The surgical team was available to personally answer my questions."

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