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Appendicitis in childhood: Usefulness of ultrasound in diagnosis
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appendicectomy was performed because of deteriorating clinical condition). The authors note that interval appendicectomy has a low complication rate and suggest that ultrasound may be an aid in deciding whether to use operative (or percutaneous) drainage of an abscess in children who do not improve with nonoperative therapy. The study reinforces the concept that it is safe (and probably preferable) to adopt a policy of treating the appendiceal mass nonoperatively.--V. Kalidasan
Interval Appendectomy in Perforated Appendicitis. D.Z Weiner, A. Katz, R.B. Hirschl, et al. Pediatr Surg Int 10:82-85, (February), 1995.
This is a retrospective study of 480 children admitted for treatment of acute appendicitis over a 10-year period. The authors chose 104 patients who were deemed to have perforated appendicitis on the basis of clinical examination, investigations (including ultrasound), or operative findings. The patients were divided into two groups: those who had primary appendectomy (n = 87) and those who were treated with IV fluids, antibiotics, and then scheduled for interval appendicectomy 4 to 6 weeks later (n = 17). It was determined that neither the length of hospital stay nor the cost between these two groups differed significantly. There were no deaths and no difference in the overall complication rate between the two groups. The group operated on primarily had a higher rate of major complications (10% versus 0% for the group managed nonoperatively). The authors note that the conservative management of perforated appendicitis is not a universally accepted policy, but believe that, based on their experience and a review of the literature, efforts at determining the safety of this policy is justified.--P. Puri
Laparoscopic Appendicitis in Childhood. G.M.E. Humphrey andA. Najmaldin. Pediatr Surg Int 10:86-89, (February), 1995. The authors reviewed the records of 31 children who underwent laparoscopic appendicectomy over a period of 18 months. Their age range was 5 to 15 years. The operating time varied from 35 to 98 minutes, and the hospital stay ranged from 2 to 8 days. Complications included one pelvic abscess and two infections at port sites. The authors used the "open Hasson" type technique for the umbilical port insertion, and point out that this is important in reducing the complications that have occurred with the Veress needle method for primary port placement. They believe that children who have had laparoscopic appendicectomy return to normal activity much more rapidly than those who have had an open operation. The limitations of the laparoscopic approach are dependent on the experience of the surgeon. The presence of adhesions, peritonitis, or a mass may not be a deterrent to those who are well experienced. P. Puri
Appendicitis in Childhood: Usefulness of Ultrasound in Diagnosis. M.J. Siegel. Pediatr Surg Int 10:62-67, (February), 1995. This article reviews the usefulness of ultrasonography (US) in children with abdominal pain atypical of appendicitis. Apart from helping to diagnose appendicitis, US is especially helpful in detecting other causes of abdominal pain. Color Doppler US recently has been added to sonographic evaluation of suspected appendicitis. This does not increase the sensitivity of US diagnosis of appendicitis but appears to "increase observer confidence." Diagnosis of appendicitis by US relies on the following findings: (1) appendicu!at tenderness by graded compression technique, (2) demonstration of a noncompressible tubular structure filled with fluid, (3) a total diameter greater than 6 mm on cross-section, and (4) a target
INTERNATIONAL ABSTRACTS
appearance of the appendix. Focal appendicitis or perforated appendicitis may be difficult to diagnose. US also will help in detecting an appendicular mass or abscess. Among children referred for US with suspected appendicitis, approximately 25% will have appendicitis and approximately 29% will be diagnosed as having other conditions. Other conditions that may be detected are gynecologic disorders, ectopic pregnancy, inflammatory bowel disease, acute terminal ileitis, mesenteric adenitis, intussusception, and urinary tract problems such as hydronephrosis and pyelonephritis.--P. Puri
Acute Appendicitis in Childhood: Experience in a Developing Country, S.W. Moore and J. Schneider. Pediatr Surg Int 10:71-75, (February), 1995. This is a retrospective study of 436 patients with appendicitis treated at Cape Town over an ll-year period. This accounted for 1.8 cases per 1,000 admissions of patients under 16 years of age. The incidence appeared to be greater among Caucasians (3.5 per 1,000) than among children of African descent or from mixed races (1.78 and 1.69 per 1,000, respectively). The mean age of occurrence was 11.65 years, and the highest incidence was in the summer months. There were two deaths; one of these patients was a neonate who also had necrotizing enterocolitis and Hirschsprung's disease. Appendicitis appears to have a lesser incidence in Polynesia, rural Africa, and Asia. A diet high in fiber and low in refined sugars has been suggested as a reason. However, there may be some ethnic factor as well, because children of mixed races who have a largely westernized diet do not show the high incidence seen among Caucasians. Intestinal helminthiasis has been cited to be the cause of appendicitis in 0.2% to 6.9% of cases. In this series, worm ova were found in 9.4% of patients.--P. Puri
Surgical Management of Meckel's Diverticulum: An Epidemiologic, Population-Based Study. ].]. Cullen, K.A. Kelly, C.R. Moir, et al. Ann Surg 220:564-569, (October), 1994. This study challenges the historic dictum that Meckel's diverticulum discovered incidentally at operation in older patients should not be removed. The study is a population-based observation of Meckel's diverticulum. The population studied was located in Olmsted County, Minnesota, in which all medical care is provided by one of two institutions. The institutions have maintained strict patient data for a number of years. Each patient with Meckel's diverticulum was a resident who had been in the county for at least 1 year; cases were tallied from 1950. Studies also included autopsies performed from 1950 to 1992. Two percent of the entire population was considered to be at risk, as suggested by earlier autopsy studies. One hundred forty-five patients underwent diverticulectomy, for a variety of indications. Incidental diverticulectomy was performed in 87 patients. Diverticulectomy was performed as a result of complications of the diverticulum in 58 patients. The mean age of patients with incidental cases was 37 years, and the median for those with complications was 23 years. Comments were based on the population study and statistical analysis. The incidence of operation for a diverticular complication was 87.4 per 100,000 person-years. The cumulative incidence of operation for complications of a Meckel's diverticulum during a lifetime was 6.4%. The likelihood of a patient with a diverticular complication requiring operation did not increase with age. The surgical techniques consisted of diverticulectomy in 65%, wedge resection in 3.5%, and segmental resection in 31%. Complications of the operative procedure included wound infection (3%), prolonged
appendicectomy was performed because of deteriorating clinical condition). The authors note that interval appendicectomy has a low complication rate and suggest that ultrasound may be an aid in deciding whether to use operative (or percutaneous) drainage of an abscess in children who do not improve with nonoperative therapy. The study reinforces the concept that it is safe (and probably preferable) to adopt a policy of treating the appendiceal mass nonoperatively.--V. Kalidasan
Interval Appendectomy in Perforated Appendicitis. D.Z Weiner, A. Katz, R.B. Hirschl, et al. Pediatr Surg Int 10:82-85, (February), 1995.
This is a retrospective study of 480 children admitted for treatment of acute appendicitis over a 10-year period. The authors chose 104 patients who were deemed to have perforated appendicitis on the basis of clinical examination, investigations (including ultrasound), or operative findings. The patients were divided into two groups: those who had primary appendectomy (n = 87) and those who were treated with IV fluids, antibiotics, and then scheduled for interval appendicectomy 4 to 6 weeks later (n = 17). It was determined that neither the length of hospital stay nor the cost between these two groups differed significantly. There were no deaths and no difference in the overall complication rate between the two groups. The group operated on primarily had a higher rate of major complications (10% versus 0% for the group managed nonoperatively). The authors note that the conservative management of perforated appendicitis is not a universally accepted policy, but believe that, based on their experience and a review of the literature, efforts at determining the safety of this policy is justified.--P. Puri
Laparoscopic Appendicitis in Childhood. G.M.E. Humphrey andA. Najmaldin. Pediatr Surg Int 10:86-89, (February), 1995. The authors reviewed the records of 31 children who underwent laparoscopic appendicectomy over a period of 18 months. Their age range was 5 to 15 years. The operating time varied from 35 to 98 minutes, and the hospital stay ranged from 2 to 8 days. Complications included one pelvic abscess and two infections at port sites. The authors used the "open Hasson" type technique for the umbilical port insertion, and point out that this is important in reducing the complications that have occurred with the Veress needle method for primary port placement. They believe that children who have had laparoscopic appendicectomy return to normal activity much more rapidly than those who have had an open operation. The limitations of the laparoscopic approach are dependent on the experience of the surgeon. The presence of adhesions, peritonitis, or a mass may not be a deterrent to those who are well experienced. P. Puri
Appendicitis in Childhood: Usefulness of Ultrasound in Diagnosis. M.J. Siegel. Pediatr Surg Int 10:62-67, (February), 1995. This article reviews the usefulness of ultrasonography (US) in children with abdominal pain atypical of appendicitis. Apart from helping to diagnose appendicitis, US is especially helpful in detecting other causes of abdominal pain. Color Doppler US recently has been added to sonographic evaluation of suspected appendicitis. This does not increase the sensitivity of US diagnosis of appendicitis but appears to "increase observer confidence." Diagnosis of appendicitis by US relies on the following findings: (1) appendicu!at tenderness by graded compression technique, (2) demonstration of a noncompressible tubular structure filled with fluid, (3) a total diameter greater than 6 mm on cross-section, and (4) a target
INTERNATIONAL ABSTRACTS
appearance of the appendix. Focal appendicitis or perforated appendicitis may be difficult to diagnose. US also will help in detecting an appendicular mass or abscess. Among children referred for US with suspected appendicitis, approximately 25% will have appendicitis and approximately 29% will be diagnosed as having other conditions. Other conditions that may be detected are gynecologic disorders, ectopic pregnancy, inflammatory bowel disease, acute terminal ileitis, mesenteric adenitis, intussusception, and urinary tract problems such as hydronephrosis and pyelonephritis.--P. Puri
Acute Appendicitis in Childhood: Experience in a Developing Country, S.W. Moore and J. Schneider. Pediatr Surg Int 10:71-75, (February), 1995. This is a retrospective study of 436 patients with appendicitis treated at Cape Town over an ll-year period. This accounted for 1.8 cases per 1,000 admissions of patients under 16 years of age. The incidence appeared to be greater among Caucasians (3.5 per 1,000) than among children of African descent or from mixed races (1.78 and 1.69 per 1,000, respectively). The mean age of occurrence was 11.65 years, and the highest incidence was in the summer months. There were two deaths; one of these patients was a neonate who also had necrotizing enterocolitis and Hirschsprung's disease. Appendicitis appears to have a lesser incidence in Polynesia, rural Africa, and Asia. A diet high in fiber and low in refined sugars has been suggested as a reason. However, there may be some ethnic factor as well, because children of mixed races who have a largely westernized diet do not show the high incidence seen among Caucasians. Intestinal helminthiasis has been cited to be the cause of appendicitis in 0.2% to 6.9% of cases. In this series, worm ova were found in 9.4% of patients.--P. Puri
Surgical Management of Meckel's Diverticulum: An Epidemiologic, Population-Based Study. ].]. Cullen, K.A. Kelly, C.R. Moir, et al. Ann Surg 220:564-569, (October), 1994. This study challenges the historic dictum that Meckel's diverticulum discovered incidentally at operation in older patients should not be removed. The study is a population-based observation of Meckel's diverticulum. The population studied was located in Olmsted County, Minnesota, in which all medical care is provided by one of two institutions. The institutions have maintained strict patient data for a number of years. Each patient with Meckel's diverticulum was a resident who had been in the county for at least 1 year; cases were tallied from 1950. Studies also included autopsies performed from 1950 to 1992. Two percent of the entire population was considered to be at risk, as suggested by earlier autopsy studies. One hundred forty-five patients underwent diverticulectomy, for a variety of indications. Incidental diverticulectomy was performed in 87 patients. Diverticulectomy was performed as a result of complications of the diverticulum in 58 patients. The mean age of patients with incidental cases was 37 years, and the median for those with complications was 23 years. Comments were based on the population study and statistical analysis. The incidence of operation for a diverticular complication was 87.4 per 100,000 person-years. The cumulative incidence of operation for complications of a Meckel's diverticulum during a lifetime was 6.4%. The likelihood of a patient with a diverticular complication requiring operation did not increase with age. The surgical techniques consisted of diverticulectomy in 65%, wedge resection in 3.5%, and segmental resection in 31%. Complications of the operative procedure included wound infection (3%), prolonged