Stump appendicitis after laparoscopic appendectomy: a rare clinical entity

Background: Stump appendicitis is an acute inflammation of the residual part of the appendix and a rare complication of incomplete appendectomy. This is a rare delayed complication after appendectomy with the reported incidence of 1 in 50,000 cases. Clinically it can be presented as acute abdomen and presents a diagnostic dilemma. Prompt recognition is important to lead to an early treatment, thus avoiding serious complications. Case study: We present a 14-year-old girl with diagnosis of stump appendicitis, who underwent surgical treatment (open appendectomy) after having laparoscopic appendectomy a month before. Radiologically (UZV and CT scan) was diagnosed an inflammatory mass with abscess dimension 41 x 21 mm in the right iliac fossa. During operation a 1,5 cm-diameter appendiceal stump was noted in the anatomical region of the appendix. The appendiceal stump was resected and inverted into the cecal wall. Histopathology examination showed acute inflammation and patchy necrosis of the appendiceal stump. The post-operative course was uneventful. Patient was discharged on third post-operative day. Conclusion: Stump appendicitis is a rare but serious complication of appendectomy. The prevalence and incidence of stump appendicitis has been increasing in the recent years. Clinical presentation of stump appendicitis mimics symptoms and signs of acute appendicitis or acute abdomen and with a previous appendectomy. So it must be considered in the differential diagnosis of acute abdomen despite the patient’s open or especially laparoscopic appendectomy history

Large Bartholin's gland cyst in a premenarchal girl: a rare clinical finding

Disorders related to Bartholin’s duct and glands affect approximately 2% of young women, and are very rare in premenarchal girls. Bartholin’s gland cysts are usualy small, do not cause any symptoms and resolve spontaneously. However, symptomatic larger cysts require medical treatment. Although many treatment modalities have been applyed, the best approach has not yet been found. Treatment modalities of Bartholin’s cyst include application of silver nitrate to the abscess cavity, incision and drainage of the cyst, curettage of the abscess cavity, placement of “Word catheter”, marsupialization, needle aspiration and alcohol sclerotheraphy, carbon dioxide laser excision and surgical gland excision. Here, we report a case of a large, soft, regular contoured painless Bartholin’s cyst located in the left labia minora with a diameter of 8 x 5 cm in an 11-year-old premenarchal girl, treated by surgical gland excision after previous unsuccessful incision and aspiration of the cyst

Clinical course and short-term outcome of postsplenectomy reactive thrombocytosis in children without myeloproliferative disorders: A single institutional experience from a developing country.

To evaluate the clinical outcome and complications in the pediatric population who had splenectomy at our institution, emphasizing the incidence of postplenectomy reactive thrombocytosis (RT) and its clinical significance in children without underlying hematological malignancies. The medical records of pediatric patients undergoing splenectomy were retrospectively reviewed for the period 1999-2018. The following variables were analyzed: Demographic parameters (age, sex), indications for surgery, operative procedures, preoperative and postoperative platelet count (postplenectomy RT), the use of anticoagulant therapy, and postoperative complications. The patients were divided into two groups according to indications for splenectomy: The non-neoplastic hematology group and the non-hematology group (splenectomy for trauma or other spleen non-hematological pathology). Fifty-two pediatric (37 male and 15 female) patients who underwent splenectomy at our institution were reviewed. Thirty-four patients (65%) were in the non-hematological group (splenic rupture, cysts, and abscess) and 18 patients (35%) in the non-neoplastic hematological group (hereditary spherocytosis and immune thrombocytopenia). The two groups did not differ significantly in regards to the patients' age, sex, and preoperative platelet count (P>0.05 for all variables). Forty-nine patients (94.2%) developed postplenectomy RT. The percentages of mild, moderate and extreme thrombocytosis were 48.9%, 30.7%, and 20.4%, respectively. The comparisons of RT patients between the non-neoplastic hematology and the non-hematology group revealed no significant differences in regards to the patients' age, sex, preoperative and postoperative platelet counts, preoperative and postoperative leukocyte counts, and the average length of hospital stay (P>0.05 for all variables). None of the patients from the cohort was affected by any thrombotic or hemorrhagic complications. We confirm that RT is a very common event following splenectomy, but in this study it was not associated with clinically evident thrombotic or hemorrhagic complications in children undergoing splenectomy for trauma, structural lesions or non-neoplastic hematological disorders

Effect of Preoperative Hormonal Therapy in Hypospadias Surgery: Evaluation of the current practice at the Pediatric surgery Clinic, Clinical Center University of Sarajevo

Introduction:The most common congenital abnormality of the penis is hypospadias. Although the main treatment is surgical; hormone therapy with dihydrotestosterone is also used.Materials and Methods: This randomized clinical trial was carried out between January 2012 and December 2017 on 79 children with hypospadias (in the Clinic of Pediatric Surgery, Clinical Centre University of Sarajevo). Their mean age was 38.2±2.8 months. GroupI included 36 children whom were treated with 2.5% dihydrotestosterone gel which was applied twice a day to the penile shaft and glans for one month prior to surgery. GroupII included 43 children whom did not receive any treatment preoperatively.Results: Mean age of patients in group I was 37.3±6.3 months and in groupII it was 39.1±5.9 months which were comparable. Complications occurring postoperatively were: urethrocutaneous fistula in 6 patients (13.9%) in group II, versus 1 patient (2.7%) in group I. There were 2 patients with meatalstenosis in group II (4.7%), and 3 (8.3%) in group I. Finally, there was a significant difference (p<0.05) between the overall reoperation rates between groups (p<0.05).Conclusion: Pretreatment with 2.5% dihydrotestosterone transdermal gel before hypospadias repair is beneficial in decreasing complication rates

Twisting of a Giant Cystic Meckel's Diverticulum in a Toddler: A Case Report and Brief Literature Review

Objective: Herein we report an unusual case of torsed giant cystic Meckel's diverticulum (MD) in a three-year-old boy, il-lustrating the rarity of this condition and briefly reviewing the literature on it. Case Report: A three-year-old boy who clin-ically presented with severe colicky abdominal pain and frequent vomiting. Abdominal ultrasonography showed a cystic le-sion in the lower abdomen. Contrast-enhanced CT revealed a well-defined right upper quadrant cystic mass measuring ~5 x 4 cm. The cystic mass appeared to be arising from the small intestine. The radiological features were not suggestive of malignancy. An urgent laparotomy was performed. At operation, he was found to have an incomplete torsed giant cystic MD. Postoperative recovery was uneventful, and the patient was discharged on the sixth postoperative day. A regular, 3-year follow-up revealed no complications. Conclusion: A giant cystic Meckel's diverticulum represents a rare cause of intra-abdominal/pelvic mass and should be considered in its differential diagnosis. Timely surgical intervention reduces morbidity and provides the best clinical outcome.Scopu

Gastric Necrosis and Perforation Following Massive Gastric Dilatation in an Adolescent Girl: A Rare Cause of Acute Abdomen.

Gastric necrosis with perforation is a rare and potentially life-threatening condition in childhood beyond the neonatal period. We report a case of gastric necrosis and perforation of a portion of the great curvature due to a massive gastric dilatation caused by pathological aerophagia in a 13-years-old, mentally impaired adolescent girl. Despite the successful surgical treatment, the patient's condition rapidly deteriorated post-operatively and she died due to the multisystem organ failure and multiple infections. In addition, we surveyed the literature on this rare condition and assessed the preventive actions to reduce this life-treating condition

Umbilical cord hernia associated with complete evagination of the patent omphalomesenteric duct and prolapse of adjacent ileal limbs

[No abstract available

Bilateral Morgagni hernia in a two-month-old infant with a history of umbilical cord hernia status repair as a neonate

Morgagni hernias (MH) are a rare form of congenital diaphragmatic hernia (CDH) characterized by herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. MH constitutes <5% of all CDH.1 Approximately 90% of MH are on the right side. MH has variable clinical presentations. Most of the cases are not discovered until later in childhood or adulthood. The differential diagnosis of MH is quite extensive and includes a pericardial cyst, loculated pneumothorax, or a hiatal hernia. MH is associated with other congenital anomalies, such as congenital heart diseases, chest wall deformities, intestinal malrotation, omphalocele, gastroschisis and chromosomal anomalies (e.g., trisomies 13, 18 and 21).2 Co-occurrence of a midline defect with MH is a rare finding frequently linked to other anatomical anomalies and genetic disorders.3 However, cases in which the etiology is unclear have also been reported.4 Concurrent MH and umbilical cord hernia (UCH) have not been reported so far. UCH may be easily misdiagnosed as a small omphalocele to similar morphologic features (Covering eviscerated abdominal contents with a sac comprising outer amnion and inner peritoneal lining). Unlike an omphalocele, UCH has an intact abdominal wall with adequate muscle development and a complete umbilical ring covered by a small skin cuff measuring ∼2.5 cm5. The possible association of UCH with the omphalomesenteric duct (OMD), especially with prolapsed persistent omphalomesenteric duct (POMD) in UCH, is possible but quite rare.

Soccer-related severe blunt splenic injury in a young goalkeeper

Abdominal injuries are rare in sports, but even minor traumas may result in potentially life-threatening injuries. The most frequent abdominal injury is abdominal wall contusion, following by blunt injuries of the kidneys and spleen. The cases of blunt abdominal injuries in soccer are rarely reported in the literature. We present a case of a grade IV splenic laceration in a 10-year-old soccer goalkeeper caused by the blunt abdominal trauma sustained during the gameplay. The trauma was successfully treated with a nonoperative management approach.Scopu