Özden Çakmak

Seven cases of neonatal appendicitis with a review of the English language literature of the last century

Neonatal appendicitis (NA) is a very rare surgical condition. The aim of this study is to once again draw attention to this subject by collecting our cases with NA and cases of NA reported separately in English-language literature over the period from 1901 to 2000. We performed a retrospective chart review of patients admitted to our hospital, with the clinical diagnosis of NA from 1990 to 2000. A survey of the English-language literature together with our own 7 cases revealed a total of 141 cases of NA during the period of 1901–2000. 128 cases had sufficient information for analysis. The patients are grouped and discussed according to these 3 time– periods: 1901–1975, 1976–1984 and 1985–2000. The incidence, etiology, and presenting signs and symptoms of appendicitis in newborns are discussed. Despite the similar perforation rates in the 3 time– periods (73%, 70%, 82%), mortality rate in NA has decreased from 78% in the 1901–1975 period, to 33% in the 1976–1984 period, and to 28% in the 1985–2000 period. A newborn baby presenting with continuous vomiting, refusal to feed, and , showing signs of pain through irritability, restlessness, sleep disturbance, and a distended abdomen; one should strongly suspect an abdominal disorder, perhaps appendicitis.

Acute scrotum — Etiology and management

Objective: Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, since no investigation can confidently exclude torsion of testis from the differential diagnosis.Methods: A review of all boys presenting with acute scrotal pain who underwent emergency scrotal exploration between January 1983 and March 2003 was performed.Results: 195 boys were included in this study. They were divided into 3 groups: group 1–73 with epididymo-orchitis, group 2–63 with torsion of testicular appendages and group 3–57 with spermatic cord torsion. The patients in group 2 were older than group 1, also patients in group 1 were older than group 3. During neonatal period the most common pathology was spermatic cord torsion, whereas in prepubertal period torsion of appendages was more common. In all boys, mean duration of pain at presentation was 2.11 days. Epididymo-orchitis was diagnosed in 37% of patients, with torsion of the appendages being the next most common entity. Testicular torsion was diagnosed in 29% of patients. In the group with testicular torsion salvage rate of testis was 37% because of late admission. The perioperative morbidity and mortality was not seen in any of the groups.Conclusion: We believe that any boy with acute scrotal pain and any suspicion of testicular torsion in physical examination must be applied routine surgical exploration.

A sewing needle migrating into the liver in a child : case report and review of the literature

Swallowing foreign bodies is a common problem in children. Although most objects pass through the gastrointestinal tract with no untoward effect; long, sharp-pointed, or slender objects can perforate the gut. Migration of an object to the liver is extremely rare and very few cases have been reported in the literature. The aim of this study is to draw attention to this subject once again by contributing a case report of a child with a hepatic sewing needle. A survey of the literature over the period from 1971 to 2006 revealed a total of five cases of childhood hepatic sewing needle together with our case. The practical lesson illustrated by this report is that the surgeon must carefully evaluate the liver when foreign body was not found in gastrointestinal system and also perforation site was found anywhere.

A huge ovarian mucinous cystadenoma in a 14-year-old premenarchal girl: review on ovarian mucinous tumor in premenarchal girls.

Superficial epithelial ovarian tumors are unusual in adolescent girls (when compared with adult women) and extremely rare before menarche. Mucinous cystadenoma (MCA) in children that is a rare form of epithelial tumor is a benign cystic ovarian neoplasm. To our knowledge, there are only eight cases of mucinous cystadenoma, three of borderline mucinous cystadenoma, and three of mucinous cystadenocarcinoma reported in the English-language literature. We present a 14-year-old premenarchal girl with a giant ovarian mucinous cystadenoma. This review is supported by the finding that epithelial ovarian neoplasms are extremely rare prior to puberty and that only 14 mucinous tumors have been reported prior to menarche.

Perforation of Meckel's Diverticulum by a Button Battery: Report of a Case

A perforation of Meckels diverticulum (MD) by foreign bodies is an extremely rare cause of acute abdomen in children. We herein present a rare case of perforation of Meckels diverticulum in a child after swallowing an alkaline button battery that contained lithium.

Retrosternal hernia (Morgagni) with colonic perforation due to incarceration

Retrosternal (Morgagni) hernias in children are usually asymptomatic or may be associated with mild respiratory distress or gastrointestinal symptoms. Incarceration of bowel in a retrosternal hernia is unusual. This report describes a complete colonic obstruction with incarceration and perforation in a Morgagni hernia.

Fetus in fetu: A report of two cases

Fetus in fetu is a rare condition that has been defined as the presence of one of the twins in the body of the other. It is most frequently located in retroperitoneal area; however, it has been reported in other locations as well. This report presents two cases of “fetus in fetu” cases: one located in the retroperitoneal area and the other in the sacrococcygeal area.

Primary hyperparathyroidism in infancy: A case report

Primary hyperparathyroidism is a rare disease of childhood. The condition is even rarer in the neonatal and infant stages. The disease, with its main manifestation-hypercalcemia-often is fatal. The authors successfully treated a 2.5-month-old boy who had primary parathyroid hyperplasia. The patient had recurrent pneumonia and failure to thrive. Blood test results showed an abnormally high level of calcium, which was resistant to medical therapy. Further investigations showed high levels of parathyroid hormone. The patient underwent neck exploration, which showed hyperplasia of the all four parathyroid glands. Total parathyroidectomy was performed, with one gland being autotransplanted to the deltoid muscle. The patient had an immediate hypocalcemic period, followed by normocalcemia. In light of the present case and others in the Literature, the authors recommended total parathyroidectomy followed by autotransplantation of a gland to an accessible muscle.

Appendiceal Mass in a Neonate After Surgery for Esophageal Atresia and Tracheoesophageal Fistula: Report of a Case

A 23-day-old girl presented with abdominal distension and vomiting. She had been previously operated on for esophageal atresia and tracheoesophageal fistula (EA/TEF) when she was 2 days old. An immediate laparotomy revealed an appendiceal mass caused by perforated appendicitis. The occurrence of appendicitis and an appendiceal mass is extremely rare in neonates and this may be the first such report in the world literature.

Adverse effects of endotoxin following massive distal bowel resection

Sepsis is a frequent cause of morbidity following extensive bowel resection. It has been suggested that the lymphoid tissues of the gut may be essential to normal humoral immunity. This study evaluates: (1) the effect of endotoxin on mortality following selective massive bowel resection and jejunoileal bypass; (2) cellular immunity by skin allograft rejection and bypass, and (3) T and B cell lymphocyte subpopulations is mesenteric lymph nodes, intestine and appendix. Endotoxin increased mortality in rats with more distal bowel resection but not following bypass. Skin allograft rejection was similar in each group. Peyers patches, mesenteric lymph nodes and appendices were evaluated for T & B cell subpopulations. These tissues had a greater percentage of B cells (53% lymph nodes, 63% appendix) with IgM the predominant immunoglobulin. Cellular immunity was not a factor. Lymphoid tissues of the distal bowel and mesentery contain abundant B cells and IgM that may contribute to humoral immunity. Massive bowel resection may increase the risk of morbidity from gram negative sepsis and/or endotoxin presumably due to decreased humoral immunity.