Acute abdominal pain in children; clinical outcomes and value of symptoms and signs in diagnosis

To determine the clinical outcomes of acute abdominal pain and evaluation of symptoms and signs in children admitted in pediatric surgery department. Cohort study. This study was conducted in Department of Paediatric Surgery Shaikh Zayed Hospital, Lahore between August 2010 to August 2012. Children aged 2 to 14 years who presented to emergency department with complaint of acute abdominal pain of less than 5 days duration and admitted in pediatric surgery department were included. Presenting symptoms, signs, hospital course of patients and discharge diagnosis were recoded. Data was analyzed by SPSS. Out of 73104 patients who were seen in Paediatric emergency 1420 [1.94%] were referred for surgical evaluation. Out of these 157 children were admitted. Six patients left against medical advice so 151 patients were studied. Patients were divided into acute appendicitis, non-specific pain abdomen and miscellaneous categories on the basis of discharge diagnosis. Acute appendicitis was diagnosed in 61[40.4%] patients. The patients who were admitted and no cause of pain abdomen could be found in them, were included in non-specific pain abdomen group. NSPA group had 39 [25.8%] patients. Rests of the 51 [33.8%] patients were included in miscellaneous group. Anorexia, fever, pain in right lower quadrant, tenderness in right iliac fossa, guarding, rebound tenderness and tachycardia were all significantly higher in patients with acute appendicitis. Most of the children with acute abdominal pain would not require surgery. Detailed history and thorough physical examination is cornerstone of the diagnosis

Predictive value of TLC and CRP in children with clinically suspected acute appendicitis

Acute appendicitis represents one of the most common abdominal emergencies in children. Initially inflammation is localized to appendix but if untreated can lead to generalized peritonitis. It is often difficult and challenging even for the most experienced surgeon to make a definite diagnosis in paediatric patients. Inflammatory markers like Total Leukocyte count [TLC] and C-reactive protein [CRP] can help in making an early and accurate diagnosis in difficult cases

Objective: To evaluate the predictive value of TLC and CRP in children with clinically suspected acute appendicitis in whom physical findings were equivocal

Study Design: Cross sectional analytical

Setting: This study was conducted in Pediatric Surgery Department of Shaikh Zayed Postgraduate Medical Institute, Lahore

Subjects and Methods: All patients from 5-14 years of age fulfilling the inclusion criteria were admitted for this study. Preoperative blood samples for total leukocyte count and CRP were collected and submitted to hematology and microbiology laboratories. Postoperatively, specimen of appendix was sent to histopathology laboratory of Shaikh Zayed Hospital. The histological results of report were differentiated into non-inflammcd and inflamed appendix

Results: The mean age of the patients was 9.9+/-2.2 years. The mean TLC of the patients was 14.1+/-6.4 [10[9]/L]. The mean CRP of the patients was 19.0+/-8.7 mg/dl. Histopathology showed that 70 [69.4%] patients had inflamed appendix. The sensitivity of TLC and CRP was 82%, specificity 75% and diagnostic accuracy was 79%. The positive predictive value of TLC and CRP was 83% and negative predictive value was 73%

Conclusion: It is concluded from the results of this study that TLC and C-reactive protein can provide help in making accurate diagnosis of acute appendicitis. There monitoring enhances the diagnostic accuracy of acute appendicitis thus reducing the morbidity associated with delay in diagnosis and negative explorations

case of sigmoid colon atresia

Atresia of the colon is one of the rare types among all the gastrointestinal atresias. Sigmoid colon is one of the rarest sites of coIon atresia. In most of the pediatric surgical centers one case per year is seen and only few cases of sigmoid atresia/ stenosis documented in literature. We report a case of male baby w o presented on 4th day of life with features of large intestinal obstruction. At laparotomy type II atresia of sigmoid colon was found, for which colostomy was done

Acute appendicitis in children; correlation of clinical data with histopathological findings

The study was conducted to identify clinical features significantly associated with histopathologically proven appendicitis in children. Cross-Sectional Observational. This study was conducted in Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore between August 2010 to August 2012. Children aged 2 to 14 years who underwent appendectomy for acute appendicitis during the study period were included. Patients who had appendectomy for any reason other than appendicitis were excluded. Presenting symptoms, signs, hospital course of patients and histopathological diagnosis were recoded. Data was analyzed by using SPSS. Sensitivity, specificity, positive predictive value and negative predictive value for each symptom and sign were calculated. Out of 1420 patients who were evaluated during the study period for acute abdominal pain, 70[5%] were diagnosed with acute appendicitis. Four patients left against medical advice so 66 patients were studied. Patients were divided into acute appendicitis and non-inflamed appendix group on the basis of histopathology of resected appendix. Acute appendicitis was confirmed histologically in 43 [65%] cases and perforated appendicitis was found in 8 [12%]. No evidence of acute inflammation was found in 15 [22%] cases. Among clinical features only involuntary guard [p-value 0.01] and rebound tenderness [p-value 0.004] were significantly different among acute appendicitis and non-inflamed appendix group. Total leukocyte count more than 11,000 was significantly higher in acute appendicitis group. The cornerstone of diagnosis of acute appendicitis in children is thorough history and meticulous physical examination. Involuntary guard, rebound tenderness and total leukocyte count more than 11,000 were significantly more prevalent in biopsy proven cases of appendicitis

Hazards of multiple magnet ingestion in children; a case report

Foreign body ingestion is relatively common in the paediatric population and most object pass through the gastrointestinal tract spontaneously. With the popularity of small magnetic toys, there have been numerous reports of magnet ingestion with morbidity and even mortality. We report a case of 3-years old boy who presented with clinical features of subacute intestinal obstruction with no history of foreign body ingestion. On exploratory laparotomy, he was found to have multiple small bowel perforations due to two small magnets. Magnets were removed and perforations repaired. The aim of this report is to aware paediatricians of the importance of early surgical referral in case of magnet ingestion, to prevent severe complications

Platelet count in malaria

To evaluate the significance of platelet count in cases of malaria at presentation. Descriptive study. Department of pathology CMH Lahore, from Aug 2007 to Sep 2008. A total of 256 patients of all ages with short history of febrile illness, rigors and chills were included in the study. Three ml blood sample was taken to prepare thick and thin blood smears. The smears were stained with Leishman's stain and examined'for malarial parasite. Complete blood counts of all the subjects were carried out with Sysmex KX -21 hematology analyzer. Out of 256 patients, 102 [40%] were positive for malaria on microscopy. 80 [31%] had Plasmodium vivax and 22 [9%] had Plasmodium falciparum infection. Thrombocytopenia was found in 66 [82.5%] and 19 [86.45%] patients of Plasmodium vivax and plasmodium falciparum respectively. Thrombocytopenia is a frequent finding in cases of malaria at presentation. Its presence in a patient with acute febrile illness increases the probability of malaria. Replacement therapy is usually not required and platelet count becomes normal after anti malarial treatment

Duhamel pull through in Hirschsprung's disease: experience at Shaikh Zayed Hospital

Hirschsprung's disease is one of the common causes of neonatal intestinal obstruction. It can even present in older child with chronic constipation. We report our experience of Duhamel's procedure for definitive treatment. Twenty patients were included in the retrospective analysis. Out of these, 11 had rectosigmoid disease, 5 had ultra-short segment disease and 4 had total colonic aganglionosis. Early complications were seen in 5 patients and 7 patients had long term problems. They all settled over a period of time

Experience with circum-umbilical incision in Infantile Hypertrophic Pyloric Stenosis at Sheikh Zayed Hospital, Lahore

Circum-umblical incision was used in 35 infants and results were studied regarding perioperative complications and hospital stay. There was a definite advantage of excellent cosmetic scar with no significant difference in morbidity. We recommend circum-umbilical Incision as an alternate approach for IHPS to right upper quadrant incision

Intralesional steroid therapy of hemangiomas

Background: Hemangiomas are the commonest benign tumors of infancy and early childhood. Their natural course includes rapid progression during first year of life followed by regression. They can produce local and systemic complications and produce anxiety of the parents, thus necessitating therapeutic intervention. Various modalities of treatment are available for the treatment of hemangiomas. In this study we evaluated the effects of intralesional steroid therapy of hemangiomas

Methods: This study was conducted in the Department of Pediatric Surgery, Services Hospital, Lahore from March 2003 to April 2004. Fifty patients of capillary, cavernous or mixed types of hemangiomas were included in this study. Injection Triamcinolon was given intralesionally in dosage of 10 mg per square centimeter of the surface area of hemangioma but not exceeding the maximum dose of 5mg/kg. Each patient was followed up at three weeks interval

Results: it was found that this form of therapy is effective, easy to perform, cost effective and have minimal side effects

Conclusion. The intralesional steroid for hemangiomas is effective treatment with negligible side effects

Infantile hypertrophic pyloric stenosis: experience with circum-umbilical incision

Circum-umbilical incision was utilized in 40 infants with infantile hypertrophic pyloric stenosis [IHPS] and the outcome compared with the same number of infants in whom a right upper quadrant incision was used. No significant difference was found regarding peri-operative complications and duration of hospital stay. We recommend the circum-umbilical incision as an alternative approach for IHPS as it provides adequate access to the pylorus, is not associated with increased morbidity and gives an excellent cosmetic scar