Management of Pediatric Appendicitis

Appendicitis is the most common surgical diagnosis for children who present with abdominal pain to the emergency department. However, there are nonspecific examination findings and variable historical features during its presentation. Diagnosis of appendicitis in the pediatric patient may be challenging for the clinician dealing with these children. It is important to have a high index of suspicion and taking a detailed history and physical examination. In diagnosis of appendicitis, adjunctive studies that may be useful are the white blood cell count, C-reactive protein, urinalysis, ultrasonography and computerized tomography when necessary. When appendicitis is suspected, patients should receive immediate surgical consultation, as well as volume replacement and antibiotics if indicated. The most accurate diagnostic tool is perhaps the serial examinations by the same examiner. With this timely approach, it will be possible to prevent the significant morbidity that is associated with delayed diagnoses in younger patients

Hair tourniquet syndrome of the clitoris and labia minora: Report of three cases and review of the literature

Hair tourniquet syndrome (HTS) is a rare condition and may pose diagnostic dilemma. The purpose of this study is to report our experience in 3 female cases with HTS involving genitalia. All the patients in this series presented with swollen and edematous genitalia and clitoris accompanied by strangulation in clitoris or labia minora with a hair thread. Strangulating hair was excised and removed under local anesthesia. The pain was cleared away and edematous discoloration disappeared immediately. Local application of antibiotic ointment was added to the treatment in these cases for a period of 6-7 days. The anatomy of the genitalia was found to be normal in these children during the follow up exam. A brief literature review on this subject is also given in this review

Epidermoid inclusion cyst after urethroplasty: A rare complication

Epidermoid inclusion cysts (EIC) is a disease caused by the nidation of the epidermal tissues and sebaceous materials into the dermal and subcutaneous layers. This entity is usually observed after trauma and surgical procedures. A 5-year-old boy with a ventral penile mass was admitted to our department. The history of the patient revealed that he was operated at the age of 1 year for hypospadias in a different medical center. The patient’s history also revealed that during the initial operation, a skin graft was used for covering urethroplasty. One year later the operation, a ventral penile mass was observed by his mother during wash. The mass continued to increase in size reaching of 1 cm in diameter. The mass was excised and the histopathological study revealed that the mass was compatible with an EIC. With 2 years of follow up the patient is disease free. EICs after penile surgical interventions may be a factor of anxiety for both the children and their parents. In order to avoid this unwanted complication, implantation of the superficial tissue layers into the deep the dermal and subcutaneous tissues should be avoided

Food foreign body injuries

Rationale and aim: The purpose of this study is to acquire a better understanding of Food Foreign Bodies (FFB) injuries in children characterizing the risk of complications and prolonged hospitalization due to food items according to patients' characteristics, circumstances of the accident, Foreign Body (FB) features and FB location, as emerging from the SUSY Safe Web-Registry. Methods: The present study uses data provided by the SUSY Safe Project, a DG SANCO co-funded project started in February 2005, which was aimed at establishing an international registry of cases of Foreign Bodies (FB) injuries in children aged 0-14 years. The analysis was carried out on injuries due to a food item.FB location was reported according to ICD9-CM code: ears (ICD931), nose (ICD932), pharynx and larynx (ICD933) trachea, bronchi and lungs (ICD934), mouth, esophagus and stomach (ICD935).Age and gender injury distributions were assessed. Data regarding adult supervision and activity before injury were also evaluated. FBs which most frequently cause complications were identified. The association between children age, adult presence, object characteristics and hospitalization/complications was computed using unweighted odds ratios and the related 95% confidence intervals. Results: 16,878 FB injuries occurred in children aged 0-14 years have been recorded in the SUSY Safe databases. FB type was specified in 10,564 cases; among them 2744 (26%) were due to a food item. FB site was recorded in 1344 cases: FB was located in the ears in 99 patients, while 1140 occurred in the upper and lower respiratory tract; finally, 105 food items were removed from mouth, esophagus and stomach. Complications occurred in 176 cases and the most documented was pulmonary or bronchial infections (23%) followed emphysema or atelectasis and by and asthma (7%). Bones were the commonest retrieved FFB encountered in this study, while nuts seem to be the FFB most frequently associated to complications. Conclusions: On the basis of this study we make the strong recommendation that parents should be adequately educated and provide age-appropriate food to their children and be present in order to supervise them during eating especially during a critical period ranging from 2 to 3 years of age