Yeliz Çağan Appak

Inflammatory myofibroblastic tumor of the colon with an unusual presentation of intestinal intussusception.

Inflammatory myfibroblastic tumor (IMT), also known as inflammatory pseudotumor is unusual, benign solid tumor. This tumor is commonly reported in the lungs but can be present in extrapulmonary sites as well. We present the case of a 7-year-old girl with IMT in an unusual location. The patient was admitted with abdominal pain, and ultrasound showed a solid mass in the abdomen. She was operated and colocolic intussusception secondary to a mass was found. Histologic evaluation of mass revealed IMT.

Coexistence of Helicobacter pylori and Intestinal Parasitosis in Children with Chronic Abdominal Pain.

OBJECTIVE The aim of this study was to determine the incidence of coinfection with Helicobacter pylori and intestinal parasitosis in children with chronic abdominal pain (CAP) and to investigate the common risk factors in the development of both infections. METHODS Ninety patients with CAP were enrolled in this study. Blood samples of each case were screened for human preformed IgG (HpIgG) antibodies, and stool samples were tested for HpSA and also examined for intestinal parasites by direct wet-mount, formalin-ethyl-acetate concentration, and Trichrome staining procedures. Cellophane tape test was used for Enterobius vermicularis. Children tested positive for HpIgG and/or HpSA were accepted as H. pylori positive. The risk factors were compared with a questionnaire. RESULTS The incidence of Giardia intestinalis was 14.8% in the H. pylori-positive group and was found to be statistically higher than that in the H. pylori-negative group (1.6%). The positivity rates of H. pylori were found to be statistically higher in children attending school and using drinking water from taps. The incidences of parasitosis were significantly higher in children with a low maternal education level and with a history of parasitosis treatment in the family. CONCLUSION The most common etiologies of CAP in children are H. pylori infection and intestinal parasitosis. İmprovement of hygienic conditions would be beneficial in preventing both infections.

The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report

CONTEXT Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.

Diagnosis and Management of Pancreatitis in Childhood: A Single-Centre Experience

Background: Pancreatitis can be seen at any age in childhood. Therefore, it is important for pediatricians to know the diagnosis and the management of pancreatitis. Objectives: The aim of this study was to evaluate the etiological factors, clinical features and management of pancreatitis in children. Methods: This study included hospitalized children who were diagnosed with pancreatitis. The clinical presentations, laboratory analyses, radiological features, etiologies and treatments were recorded. Results: A total of 59 pancreatic attacks were recorded in 41 patients. The most common symptoms were abdominal pain and vomiting, and the most common etiological cause was idiopathic. Approximately 22% of the patients had acute recurrent episodes. Somatostatin was used to treat 61% of the attacks; however, it did not reduce the time to recovery after an attack when compared to those patients who did not use somatostatin (P = 0.36). The white blood cell counts and urea and calcium levels were significantly different between those patients who did and did not use somatostatin. Seventeen (28.8%) of the pancreatitis attacks were determined to be severe. Moreover, a mutation in the cystic fibrosis transmembrane conductance regulator was detected in two patients with recurrent pancreatitis. Conclusions: Fever and irritability can be signs of pancreatitis in infants and toddlers. In our cases, the somatostatin treatment was not effective in terms of the time to recovery after an attack.

Etiology and Outcome of Cholelithiasis in Turkish Children

ObjectiveThe aim of this study was to examine the etiology of gallstones in children and responses to ursodeoxycholic acid (UDCA) treatment.Methods74 children with cholelithiasis were recruited, and underwent ultrasonography to detect gallstones. All relevant clinical information was recorded in a structured proforma.ResultsThe commonest risk factor was a family history of gallstones. Most children responded to UDCA treatment in the first six months; children with hemolytic diseases showed no response to UDCA.ConclusionUDCA treatment may be useful before surgery in asymptomatic patients of cholelithiasis without hemolytic diseases.

The Association of Choledochal Cyst and Pancreatitis: A Case Report and Review of the Literature

Choledochal cysts are uncommon congenital anomalies of the bile ducts. The incidence of choledochal cyst is reported to be 1/100000-150000 in western societies, whereas it is 1/1000 in Asian societies (1). Although choledochal cysts are usually observed in childhood, they are seen in adults in 25 percent of the cases. Many complications can occur before and after surgery in patients with choledochal cyst. It was argued that pre-operational pancreas involvement could be a risk factor for a possible post-operational pancreatitis (2). This case report aims to discuss the association of choledochal cyst and pancreatitis in the light of the literature, and emphasize the necessity of being careful about acute pancreatitis after choledochal cyst operations.

Relationship Between Duodenal Histopathology and Strong Positive Tissue Transglutaminase Antibodies in Children with Celiac Disease

Öz Giriş: Çölyak hastalığında (ÇH) güçlü pozitif doku transglutaminaz antikor (DTGA) düzeylerinin (≥100 U/A) hemen daima villöz atrofiye işaret ettiği gösterilmiştir. Bu çalışmanın amacı ≥100 U/A immünoglobulin (Ig) A tipi DTGA düzeylerinin ÇH tanısındaki yeterliliğini ortaya koymaktır. Gereç ve Yöntem: DTGA pozitifliği nedeniyle endoskopik duodenum biyopsisi yapılan 197 çocuk retrospektif olarak incelendi. IgA DTGA düzeylerinin pozitif değeri >18 U/A idi. Bu eşik değerinin 5 kat veya daha üzerindeki artışlar (≥100 U/A) güçlü pozitiflik olarak kabul edildi. ÇH tanısı ESPGHAN ölçütlerine göre konuldu. Modifiye Marsh evre ≥2 ÇH için anlamlı kabul edildi. Bulgular: Olguların 129’u (%65,5) kız, 68’i (%34,5) erkekti. Duodenum histopatolojisi; olguların 1’inde (%0,5) Marsh 0, 17’sinde (%8,6) Marsh 2, 41’inde (%20,8) Marsh 3a, 81’inde (%41,1) Marsh 3b ve 57’sinde (%28,9) Marsh 3c ile uyumluydu. Yüz doksan yedi olgunun 64’ünde (%32,5) DTGA ≥100 U/ml idi. Güçlü DTGA pozitifliği saptanan olguların duodenum histolojisi 63’ünde Marsh 3 (villöz atrofi) ve birinde (tip 1 diyabetli ve ÇH açısından asemptomatik) Marsh 0 (normal histoloji) ile uyumluydu. DTGA ≥100 U/A olmasının Marsh 3c’nin varlığı için duyarlılığı %85,96 (%95 CI: %74,2-%93,7). Özgüllüğü %89,29 (%95 CI: %82,9-%93,8), pozitif tahmin değeri %76,56 (%95 CI: %64,3-%86,2) ve negatif tahmin değeri %93,9 (%95 CI: %88,4-%97,3) idi. Sonuç: Bu çalışma güçlü pozitif Ig A DTGA düzeylerinin (≥100 U/A) neredeyse her zaman Marsh 3 duodenal histopatolojik değişikliklerle beraber olduğunu göstermiştir. Biyopsi yapılmadan ÇH tanısının konulması ÇH’ye eşlik eden bazı hastalıkların atlanmasına neden olabilir; fakat ileri tetkik edilmiş seçilmiş bazı olgularda çocuk gastroenteroloji uzmanları tarafından endoskopi yapılmadan da ÇH tanısı konulabilir. Introduction: In celiac disease (CD) strong positive tissue transglutaminase antibody (TTGA) levels (≥100 U/A) have been shown to almost always indicate villous atrophy. The aim of this study is to determine the sufficiency of ≥100 U/A Ig A type TTGA levels for diagnosis of CD. Ya zış ma Ad re si/Ad dress for Cor res pon den ce: Dr. Fatih Ünal, Dörtçelik Çocuk Hastanesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Bursa, Türkiye Tel.: +90 532 442 08 99 E-posta: drunalfa@yahoo.com.tr Anah tar ke li me ler Çölyak hastalığı, doku transglutaminaz antikoru, duodenum, histopatoloji