H. Louati

Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort.

PURPOSE To evaluate whether C-reactive protein (CRP) level and ultrasound (US) results on admission could aid the diagnostic accuracy of Alvarado score. METHODS A prospective study was performed on children <14 years admitted for suspected acute appendicitis. Patients were categorized into three groups based on the Alvarado score: group I: score 7-10, group II: score 5-6, group III: score 0-4. RESULTS The difference between predictive values of Alvarado score alone and Alvarado score with CRP was not statically significant. The PPV increased from 74.29% (Alvarado score and CRP) to 93.75% (Alvarado score and US) in group 1 (P = .001) and the NPV increased from 64.86 and 79.69% (Alvarado score and CRP) to 82.6 and 88.2% (Alvarado score and US) in group 2 (P = .01) and group 3 (P = .001), respectively. CONCLUSIONS Alvarado score and ultrasound taken together improve the predictive value of diagnosing acute appendicitis in children.

Predictive factors of negative appendectomy in children

Acute appendicitis (AA) is one of the most common pediatric surgical conditions seen in children. The annual incidence of AA is 37.2 per 10,000 American children between the ages of 0–14 years [1]. The decision to perform operation on a patientwith suspectedAA is basedmainly on disease history and physical findings and ultrasound findings [2]. However, the diagnosis of acute appendicitis in children is often challenging. This may be related to the variable presentation and greater diagnostic uncertainty in younger children presenting with acute abdominal pain. Since delayed diagnosis and treatment of AA are associated with increased length of stay, postoperative complications and mortality, timely intervention is crucial [3-5]. Therefore, it is important to identify clinical predictive factors of appendicitis in order to reduce negative appendectomy rates. The aim of this study is to compare two groups of patients and to assess predictive factors for negative appendectomy in children. A total of 540 patients who underwent surgical treatment for acute appendicitis from January 2013 to December 2016 were included in this study. There were 343 males and 197 females and their mean age was 9.23 ± 2.78 years (range, 2–14 years). Of the 540 patients, 316 (58.5%) were diagnosed with simple appendicitis, 164 patients (30.4%) were diagnosed with complicated appendicitis, and 60 patients (11.1%) were diagnosed with a normal appendix. The negative appendectomy rate was 11.1%. White blood cell (WBC) count and C reactive protein (CRP) were performed in all patients. Ultrasound (US) was performed on 371 (68.7%) patients. The mean WBC count, CRP level, and maximal outer diameter (MOD) of the appendix on US for all cases

Laparoscopic percutaneous extraperitoneal closure procedure for pediatric femoral hernia: case report

Femoral hernias are misdiagnosed in children. A 5-year-old boy who was operated for a right indirect inguinal hernia at the age of 3 was at our department by conventional route. However, a right inguinal bulge developed at 3 months after the first operation. Laparoscopy demonstrated that the patient had femoral hernia, which was located easily. The femoral orifice was closed using our LPEC method with non-absorbable thread. The patient’s postoperative course was uneventful. The femoral hernia repair method using an LPEC needle turned out to be easy, safe and produce good cosmetic results.