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.
Among the procedures performed are:
- Biopsy
- Correction of biliary atresia
- Correction of congenital anomalies of the chest and abdomen
- Correction of liver disorders
- Correction of neonatal surgical conditions
- Correction of portal hypertension
- Hernia repair and orchiopexy
- Intersex procedures
- Laparoscopic, thorascopic and laser procedures
- Non-surgical treatment of burns
- Procedures for disorders and abnormalities of the esophagus and trachea
- Renal transplantation
- Tumor procedures
Our family-centered approach to caring for children at Children's National has grown to become one of the most experienced and respected pediatric surgical programs in the world. Our team of pediatric general surgeons are joined by nurse practitioners and other health care professionals to deliver the highest quality and most technically advanced surgical care available for children.
Download a pdf of these guidelines.
General and Thoracic Surgery 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:
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:
Data Needed:
-
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:
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:
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:
-
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:
Data Needed:
-
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:
-
Vascular Anomalies:
Hemangiomas/Lymphatic or Vascular Anomalies
Initial Work-Up:
Referral When:
- For further management and advice, contact Children’s Vascular Anomalies Clinic at 202-476-2151.
Data Needed:
- Clinic notes
- Any imaging studies