Turan Yildiz

Simple patch closure for perforated peptic ulcer in children followed by Helicobacter pylori eradication

Objective: Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of children who have undergone operations for perforated duodenal ulcers. We report our experience with the modified Graham technique for perforated duodenal ulcers in nine children and review the literature. Methods : The records of patients operated on for a perforated duodenal ulcer in the last 8 years in two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to admission to hospital, operative findings, and postoperative clinical course were evaluated. Results : Nine children (mean age 13.2 years, range 6–170 years) were included. All patients were admitted in the first six hours after their abdominal pain started. In three patients, there was free air on plain x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for Helicobacter Pylori, and the results were positive. All patients underwent triple therapy with lansoprazole, amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3–94) months. Conclusions : Peptic ulcer perforation should be suspected in children who have acute abdominal pain and peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in children.

Analsis of the risk factors for child appendicitis

BACKGROUND Appendicitis is the most common form of abdominal pain requiring surgery among children. This study evaluates the association of age, sex, seasonal, and familial factors with the histopathology of appendectomies. METHODS 588 patients who underwent operations for acute appendicitis between 2009 and 2011 were included in this study. The patients were classified in one of three groups based on histopathological results: acute, perforated, and negative appendectomy. This study evaluates the association between age, sex, seasonal, and familial factors and the histopathological classification. RESULTS The mean age of the patients was 11.8±3.26 years (range 1 to 16 years). Among these patients, appendicitis was 2.41 times more common in children greater than 10 years old. Appendicitis occurred 4.63 times more often among males than in females. Negative appendectomy occurred more often in children greater than 10 years of age. Appendicitis was associated with both seasonal factors and family history; however this association did not meet the threshold for statistical significance (p>0.05). DISCUSSION The age and sex of the patient should be taken into account when considering appendicitis surgery to improve the accuracy of the diagnosis. In addition, the histopathology of appendicitis is influenced by familial and environmental factors.

A Rare Cause of Chylothorax in Children: Gorham-Stout Syndrome

Gorham-Stout disease is a complex disease in which lytic lesions of bone tissue are accompanied by chylothorax and abdominal lymphangioma. The etiology is still unknown. The diagnosis is made by the patient’s clinical and laboratory findings and biopsy results. It may be fatal depending on the organs involved. Although many treatments have been described, successful results have been reported with interferon alpha 2b in recent years. We discuss the clinical diagnosis and treatment of a 5-year-old female patient with osteolytic lesions in the bones after she was referred with chylothorax.

Çocuklarda Nadir Bir Karında Kitle Nedeni; Yersinia Pseudotuberculosis

Yersinia pseudotuberculozis (YP) enfeksiyonu ozellikle gelismis ulkelerde giderek artmaktadir. YP nadiren lenf adenit ve karinda sag alt kadranda kitleye neden olarak ameliyat edilmektedir. Olgumuz 12 yasinda kiz hasta, kusma ve karin agrisi nedeni ile yapilan incelemede (Fizik Muayene, Ultrasonografi ve Bilgisayarli Tomografik degerlendirme) sol alt kadranda kitle tespit edilerek ameliyat edildi. Once diagnostik laparoskopi yapildi, sol kadranda kitle oldugu goruldu ve laparatomi yapilmasina karar verildi. Kitlenin abselesmis lenfadenit olmasi nedeniyle YP olabilecegi dusunuldu. Laparotomide apse drenaji, mezenter ve lenf nodu biyopsisi alindi. Ameliyat sonrasi tani seroloji ve patoloji ile YP olarak dogrulandi. Hastanin tedavisi duzenlenip postoperatif 10 gunde sorunsuz olarak taburcu edildi. Postoperatif ucuncu ay kontrolunde klinik ve ultrasonografi bulgulari normaldi. Uzun suren karin agrisi nedeni ile basvuran ve karninin herhangi bir bolgesinde kitle saptanan hastalarda bazen goruntuleme teknikleri ayirici tanida yetersiz kalabilmektedir. Cerrahin ikilemde kaldigi bu kitlelerde YP ayirici tanida dusunulmelidir. Hastanin YP icin serolojik analizinin yapilmasi dogru taniyi saglayacak ve gereksiz cerrahi girisimi engelleyecektir.Anahtar Kelimeler: Yersinia Psodotuberculosis; Karin Agrisi; Kitle; Cocuk

Parasites in the Etiology of Pediatric Appendicitis

OBJECTIVE Appendicitis is the most common cause of operation in the children. Fekalit, lymphoid hyperplasia, parasites and foreign bodies are accused as the causes of appendicitis. In this study, we wanted to evaluate that the role of parasitic infections in pediatric appendicitis. METHODS Histopathological results of the patients who underwent operations for acute appendicitis between January 2008 and 2014 were evaluated. The patients who have parasite in appendiceal specimens were detected and parasites were recorded. RESULTS Fourteen of 846 patients underwent appendectomy, were classified as parasitic appendicitis. Enterobius vermicularis was observed in 12 and Taenia spp. was observed in 2 patients, Three children with appendicitis had parasitic infection in pathological examination. Two of them were Enterobius vermicularis, and one was Taenia spp. CONCLUSION Enterobius vermicularis is the most common parasites in appendiks. Parasites often cause abdominal pain at right lower quadrant without any inflammation in the appendiks. However, parasites are responsible for some appendicitis as an etiologic factor. In our study, 0.39% of patients with appendicitis, parasites were also detected. As a result, we think that right lower quadrant pain and the incidence of appendicitis will reduce by time with the diagnosis and treatment of parasites.