A. Pane

Strictureplasty and intestinal resection: different options in complicated pediatric-onset Crohn disease

BACKGROUND/PURPOSE Surgical resection or strictureplasty (SP) are different options for intestinal Crohn disease (CD) strictures. The aim of this article is evaluation of long-term outcome of SP and resection. METHODS From 1996 to 2011, 39 patients (23 male, 16 female) with symptomatic ileal and ileocolonic CD strictures resistant to medical/nutritional therapy and treated with surgery in 2 different surgical units were reviewed. The mean age at diagnosis was 11.82 years (range, 4-17 years). Mean age at surgery was 15.94 years (range, 4-24 years). Mean follow-up was 6.88 years (range, 0.5-15 years). Patients underwent resection (group A) or different SP techniques (group B). RESULTS Twenty patients underwent intestinal resection (ileal or ileocolonic resection), and 19 patients underwent SP (jejunal, ileal, or ileocolic). Early postsurgical complications were observed in 2 patients of group A. Follow-up of group A patients revealed that 1 patient needed emergency treatment after 8 months surgery because of adhesions and 1 patient developed recurrence treated with medical therapy. In the follow-up group B, 3 patients experienced disease recurrence, 2 of them at the site of previous surgery. CONCLUSIONS At long-term follow-up, no significant difference in relapsing rate was observed between the 2 groups. Strictureplasty and resection represent an effective treatment of pediatric CD strictures. Strictureplasty could represent the first option for intestinal preservation.

Acute appendicitis in children: not only surgical treatment

PURPOSE An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. METHODS Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24-48h it was worsening, the conservative approach failed and patients underwent late surgery. RESULTS A total of 362 pediatric patients were included. One hundred sixty-five underwent early appendectomy; 197 patients were at first treated conservatively: of these, 82 were operated within 24-48h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound. CONCLUSIONS Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservatively; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure. TYPE OF STUDY treatment study. LEVEL OF EVIDENCE II.

Pediatric ileal intussusception due to Peutz Jeghers syndrome: a rare case report

We report an unusual case of ileal intussusception in a 7-year-old girl affected by Peutz Jeghers syndrome, characterized by a very misleading clinical presentation, resembling chronic constipation. Correct diagnosis was guided through appropriate knowledge of inherited condition and cautious ultrasound monitoring. Confirmation was achieved by a timely surgical intervention and subsequent pathologic examination.

Video capsule diagnosis of intestinal duplication in a 15-year-old patient.

We report here the case of a 15−year−old patient with symptoms characteristic of intestinal bleeding and severe anemia, who required repeated transfusions. The hematochemical parameters (erythrocyte sedimentation rate, CRP (c−reactive pro− tein), antineutrophil cytoplasmic antibo− dies, anti−Saccharomyces cerevisiae anti− bodies (ASCA), antiendomysium antibo− dies, and the transglutaminases), and esophagogastroduodenoscopy and colo− noscopy examinations, including histolo− gy, were normal.