rare late complication of Meckel's diverticulum: diverticulitis induced parietal abscess presenting with multiple abdominal wall fecal fistulae. a case report and review of the literature

This paper presents a case report of 5 years old boy who presented with abdominal pain and fever to the pediatric reception room since four weeks. He was examined and investigated and the possibility of appendiciditis was excluded and a diagnosis of acute non specific mesenteric adenitis was coined. Follow-up medical treatment with antibiotics and conservative measures yielded a parietal abscess in the right iliac region. Simple incision drainage revealed pus and intestinal fecal content. A fecal fistula of appendicular origin was thought for and conservative management continued. However, investigation revealed a communication to the small intestines, and the multi-orifices draining fistulae caused a severe water and electrolyte imbalance with acidosis and emaciation. A decision at exploration revealed a complicated Meckel's diverticulitis, stuck to the abdominal wall and penetrating the muscular wall to end in an arborisation of fistulae in the right iliac fossa and right lumbar region. Resection anastomosis ensured a sound healing of the condition. The peritoneal cavity was exempted from any leak or peritonitis

Clinical immunological and pathological study of thyroid swellings in children and their management

Thyroid swellings in childhood pose an important diagnostic and therapeutic problem. The study was conducted to determine the different causes of thyroid swellings in children in Alexandria and their management; and to evaluate the different noninvasive diagnostic tools. Thirty three patients [22 girls and 11 boys][mean age 10.5 +/- 3.6 years] presenting with thyroid swellings and 13 healthy children [8 girls and 5 boys] were included in the study. Serum total triiodothyronine [RIA], total thyroxine [RIA], thyroid stimulating hormone [RIA], and antithyroid peroxidase [TPO] antibodies [ELISA] were measured in all subjects. The thyroid gland was scanned using real time high resolution ultrasonography. Histopathologic examination was performed in 17 cases treated surgically. Fifteen patients [45.5%] had diffuse goitre while solitary and multiple nodules were present in 30.3% and 24.2% of the patients, respectively. Chronic lymphocytic thyroiditis [CLT] constituted the most common cause of goitre [36.4%], followed by: Graves' disease [12.1%], simple colloid goitre [12.1%], dyshormonogenesis [9.1%], follicular adenoma [9.1%], simple multinodular goitre [9.1%], papillary carcinoma [6.1%], simple cyst [3%], benign teratoma [3%], and amyloidosis [3%]. Serum antiTPO antibodies were positive in 83.3% and 75% of patients with CLT and Graves' disease, respectively, but negative in all other conditions. Ultrasonography gave an accurate differentiation between nodular [solitary or multiple] and diffuse disease. All subjects with hyperthyroid goitre were due to Graves' disease. CLT and dyshormonogenesis were responsible for the hypothyroid goitre. Sixty percent of solitary thyroid nodules were due to focal CLT and follicular adenoma. Papillary carcinoma represented 20% of these nodules. Appropriate surgery was performed mainly in nodular goiter