M. Zouari

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

PURPOSEnTo evaluate whether C-reactive protein (CRP) level and ultrasound (US) results on admission could aid the diagnostic accuracy of Alvarado score.nnnMETHODSnA 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.nnnRESULTSnThe 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.nnnCONCLUSIONSnAlvarado score and ultrasound taken together improve the predictive value of diagnosing acute appendicitis in children.

Single-port laparoscopic ovarian transposition in an 11-year-old girl.

Ovarian transposition was the first procedure proposed for children with cancer to preserve ovarian function from damage caused by abdominal and pelvic radiotherapy. In this paper, we describe the first pediatric case of single-port laparoscopic ovarian transposition.

Hybrid laparoendoscopic single-site (LESS) pyeloplasty: Initial experience in children

BACKGROUND AND OBJECTIVEnMini-invasive surgery is still evolving to get better surgical conditions for patients with ureteropelvic junction obstruction. We used technical modifications (hybrid pyeloplasty) that simplify surgical steps of laparoendoscopic single-site pyeloplasty in children. Our aim was to compare hybrid pyeloplasty to laparoendoscopic single-site pyeloplasty and to open pyeloplasty.nnnPATIENTS AND METHODSnWe retrospectively reviewed records of patients with ureteropelvic junction obstruction aged<14years undergoing pyeloplasty at our institute from January 2011 to December 2015. Demographic data, laterality, operative time, length of hospital stay, drainage tubes, and postoperative complications were recorded. Surgical outcomes were evaluated based on renal sonography and Lasix diuretic renography.nnnRESULTSnAmong 38 patients, 17 underwent open pyeloplasty (group I), 10 had laparoendoscopic single-site pyeloplasty (group II) and 11 had hybrid pyeloplasty (group III). The mean age at the time of operation was 55 months. The operative time in group III was significantly shorter than that in group I and group II (P<0.001). The shortest median hospital stay was noted in the group III. The mean follow-up period was 26 months (range: 6-52 months).nnnCONCLUSIONnThe hybrid pyeloplasty using LESS combine the successful outcomes of open surgery and advantages of minimally invasive surgery. It offers small incision surgery, good working space, short operation time, secure anastomosis and good cosmetic results.nnnLEVEL OF EVIDENCEn5.

Congenital diaphragmatic hernia with intrathoracic kidney: unusual presentation

A 2-year-old female child was admitted due to recurrent episodes of dyspnea. She was born at full term by vaginal delivery, with a birth weight of 3200 g. Prenatal ultrasound detected no abnormality. A chest radiograph (Figure 1) showed air-filled loops of the bowel in the right hemithorax. Computed tomography of the chest (Figure 2) demonstrated an ectopic reniform structure with bowel loops in the right hemithorax. Thoracoscopy revealed a posterolateral defect in the diaphragm with a thin membrane. The right kidney could be easily identified in the hernia sac. The hernial contents were reduced and the diaphragmatic defect was closed by primary repair. The right kidney was mobilized without difficulty into a near-normal site. Postoperative recovery was uneventful. The child has been followed up for 2 years without any problem, and no renal pathology was detected on ultrasonographic studies.

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

Is there a Place for Prebiotics in the Management of Neonatal Inguinal Hernia? A Preliminary Study

The objective of this study was to assess the place of prebiotics in the management of neonatal inguinal hernia. Boys with a diagnosis of unilateral non-complicated inguinal hernia, aged less than 40 days, were prospectively followed from January 2012 to December 2014. Clinical and psychiatric data and outcomes were collected before and after prebiotics (Primalac AC) administration. Ninety-eight patients were included. There were 75 inguinal hernias and 23 inguino-scrotal hernias. Before prebiotics administration 72.2% of infants had abdominal distention and 98% had colic. After prebiotics, abdominal distention and colic regressed in 85.2% and 73.2% of patients, respectively. Hernias disappeared clinically in 66.3% of cases. The factors associated with the disappearance of hernias were the type of the hernia (p<0.001), colic (p<0.001), and abdominal distention (p<0.001). Prebiotics would be a new adjunct in the management of neonatal inguinal hernia. They decrease colic and abdominal distention, which seems helpful to prevent strangulation and probably get spontaneous resolution of small hernias.

Solitary hepatic lymphangioma in an 8-month-old child

The cystic lymphangioma of the liver is an extremely rare benign tumor that usually belongs to a systemic lymphangiomatosis. An 8-month-old boy came to our Department due to abdominal distension. On physical examination, a palpable abdominal mass was noticed on the right upper quadrant, with voluntary guarding and no peritoneal irritation. Laboratory tests did not produce any positive findings. Abdominal ultrasound revealed a hepatic cyst measuring 14.9 cm × 10.7 cm × 9.7 cm in the right hepatic lobe. An enhanced abdominal CT scan confirmed a cystic hepatic lesion with no capsule. There were no definite septations or solid elements within the cyst. At laparotomy, a giant unilocular cyst arising from the visceral surface of the right lobe of liver extending into whole abdominal cavity and pelvis was observed. Complete excision of the cyst was performed. The pathology report defined the tumor as a cystic hepatic lymphangioma.

Syndrome cave supérieur secondaire à la pose d’un cathéter veineux central chez un nouveau-né

Le recours aux catheters veineux centraux (CVCs) est frequent en milieu pediatrique et neonatal. La mise en place chirurgicale de ces catheters necessite le plus souvent la ligature de la veine jugulaire interne (VJI) homolaterale. Nous rapportons le cas dun nouveau ne de sexe feminin, premature a 30 semaines damenorrhee, admis a lâge de 50 jours (âge corrige a 37 semaines damenorrhee) pour pyelonephrite gauche compliquee dabces renaux, arthrite septique multifocale et etat de choc septique. La naissance a ete faite par cesarienne pour une rupture prematuree des membranes de 5 jours. Le poids de naissance a ete de 1600 g. Devant la necessite dune alimentation parenterale et dune antibiotherapie adaptee par voie veineuse, un CVC de type Broviac a ete mis en place au niveau de la VJI droite. Levolution a ete marquee par lablation accidentelle du catheter au bout de 24 heures. La VJI droite etant sacrifiee, on a opte pour la pose dun deuxieme catheter de type Broviac au niveau de la VJI gauche. Levolution a ete marquee par linstallation, au bout de 6 heures, dun œdeme de la face et du cou avec dyspnee et cyanose. Lablation du catheter avec reprise de la meme incision cervicale, identification et anastomose des deux bouts de la VJI gauche a permis de repermeabiliser cette veine avec regression rapide de lœdeme.

Single scrotal-incision orchidopexy for palpable undescended testis in children

Abstract Objective: To evaluate the single scrotal-incision orchidopexy (SSIO) technique in patients with an undescended testis palpable in the inguinal canal or below the external inguinal ring. Patients and methods: Between January 2011 and December 2013 we performed 100 SSIOs in 89 patients. The mean (range) follow-up was 9 (3–36) months. Results: In 88 testes the SSIO was performed with no difficulties. In four patients an additional dissection by opening the external ring and canal was necessary; none of these patients developed an inguinal hernia after surgery. In eight patients conversion to an inguinal approach was necessary because of difficulty in controlling the hernial sacs and inadequate mobilisation. At the follow-up assessment, of the 89 patients, none developed testicular atrophy, one (1%) had wound dehiscence and four (5%) had a scrotal haematoma. There was no statistically significant difference between the testicular size at baseline and that during the follow-up. At 3 months after surgery the overall cosmetic result was excellent. Conclusion: The SSIO is minimal-access surgery allowing less dissection, less discomfort for the patient, rapid healing, excellent cosmetic results and a good success rate. This technique is safe and effective for undescended testes palpable in the inguinal canal or below the external inguinal ring.