RESUMO
Objective: To suggest the use of the Pediatric appendicitis score (PAS) for diagnosing acute pediatric appendicitis in a community hospital. Methods: We retrospectively reviewed the data of 285 patients aged 3 to 17 years who underwent abdominal computed tomography (CT) for suspected acute appendicitis at a single community hospital. The PAS score was compared with the CT findings in the appendicitis (n=86) and non-appendicitis (n=199) group. Results: The appendicitis group had a significantly higher PAS and more frequently positive CT findings for appendicitis than the non-appendicitis group (P<0.01). There were no significant differences in the diagnostic performance of the PAS and CT. Patients with a PAS of 1 to 3 could be discharged without further imaging study, those with a PAS of 4 to 6 might need to undergo further imaging study, and those with 7 to 10 PAS required surgical consultation with imaging study. Conclusions: The application of this score could help in reducing the reliance on CT and in standardizing the clinical assessment in a community hospital.
RESUMO
Background: Small bowel volvulus caused by a jejunal trichobezoar is an extremely rare and life-threatening emergency in children. Case characteristics: An 8-year-old girl with abdominal pain and persistent bilious vomiting. Observation: The abdominal computed tomography scan showed a solitary intraluminal mass and a whirl sign, suggesting the small bowel volvulus. Emergency laparoscopic exploration revealed the rotated segment of small bowel loops by a jejunal trichobezoar. Outcome: Satisfactory recovery after surgery. Message: Trichobezoars should be considered in the differential diagnosis of abdominal pain and projectile vomiting in children.