Appendicitis-Like Picture Induced by Foreign Body in a 2-Year-Old Boy

Background and Aim. Appendicitis is unusual in toddlers and foreign body- (FB-) induced appendicitis is rare. We present a FB-induced appendicitis in a toddler with no suggestive history of FB ingestion. Case Presentation. A 2-year-old healthy boy presented to the emergency department with irritability for 3 days duration associated with fever of 39°C, nausea, anorexia, and vomiting. There was no history of foreign body ingestion. The abdomen was distended and diffusely tender. An abdominal ultrasound (US) was suggestive of perforated appendicitis with appendicular mass formation. An abdominal X-ray showed a pin-like foreign body in the abdomen. An emergent appendectomy was performed. Intraoperatively, a sealed small cecal perforation was noticed. A 5 cm pin-like metallic foreign body was found to obstruct the appendicular lumen. The appendix was grossly normal without inflammatory changes. Conclusion. FB-induced perforations or appendicitis albeit in patients with no history of FB ingestion or infants and toddlers need a high clinical suspicion to prevent the delay in diagnosis and the subsequent complications

Paraduodenal hernias in children: Etiology, treatment, and outcomes of a rare but real cause of bowel obstruction

tINTRODUCTION: Paraduodenal Hernia (PDH) is the most common variant of internal hernia and occursmost often in males during their 4th–6thdecades of life. PDH in pediatric age group has rarely beenreported in literature with only five cases of age up to 10 years were reported. PDH is a rare cause ofintestinal obstruction, which may lead to subsequent strangulation and perforation of the bowel.PRESENTATION OF CASE: We reported a 1.5 year-old male child presented with intestinal obstruction. Thepatient experienced abdominal pain, vomiting and irritability. Abdominal x-ray showed distal intestinalobstruction which was discovered to be a result of left PDH incidentally during the surgery. In addition,we performed a literature search using PubMed to identify the published cases of PDH. We also comparedour case with the characteristics of all reported PDHs in toddlers and children up to 10 years of age in aconcise table.DISCUSSION: Despite its congenital origin, PDH has been reported in childhood age group in very rareoccasions rendering the accurate incidence of PDH in infancy and childhood unknown. PDHs can beasymptomatic or can present most commonly with recurrent upper abdominal pain. Diagnosis is quitedifficult in the absence of symptoms but could be achieved using a computed tomography (CT-scan) innon-emergency symptomatic patients. Surgical repair is mandatory to avoid potential complications.CONCLUSION: As PDH can lead to major and life threatening complications, it must remain in our mindsas a possible cause of intestinal obstruction.No funding or grant support

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population