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Referral Guidelines

General and Thoracic Surgery


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:

Guidelines: 

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


General and Thoracic Surgery - Referral Guidelines - Departments & Programs - Children's National Medical Center