Positive and Negative Rates in Children with Acute Appendicitis

Background: Acute appendicitis remains the most misdiagnosed condition worldwide. Children tend to present with a variety of clinical symptoms, may have difficult communication and could be difficult to examine

Design: A Retrospective Study

Setting: King Hamad University Hospital, Bahrain

Method: One hundred thirty-six patients who had appendectomy were reviewed between 1 May 2012 and 31 March 2016. The final diagnosis of acute appendicitis was the histological analysis of the excised specimen

Result; One hundred thirty-six underwent appendectomy and were included in this study between 1 May 2012 nd 31 March 2016. One hundred sixteen [85%] patients had uncomplicated appendicitis and 16 [12%] patients had complicated appendicitis. Four patients were histologically negative; Negative Appendectomy Rate [NAR] was 2.9%. Twelve patients had perforation; therefore, the Perforation Rate [PR] was 8.8%. Sixty-six [49%] laparoscopk appendectomies and 70 [51%] open appendectomies were performed. There was no significant difference between hospital stay and surgical technique; the average stay was 4.3 days

Conclusion: Our study has demonstrated NAR of 2.9% for a histologically normal appendix; a perforation rate of 8.8%. This study revealed the need for a prospective study for the pediatric acute abdomen and a dedicated radiological resource focused on pediatric radiology. The diagnosis of appendicitis in children remains largely clinical with appropriate use of US

Tracheoesophageal atresia and fistula: a case of mistaken identity?

Tracheoesophageal atresia with or without fistula presents shortly after birth with difficulty in swallowing saliva, history of polyhydramnios and failure to pass a nasogastric tube which coils in the proximal blind ending esophagus. Early thoracotomy and primary anastomosis within a few hours of birth have produced a significant survival result; mortality is associated with coexisting serious cardiac disease, late diagnosis and presentation. The majority of patients have a fistula which could result in significant pulmonary contamination with saliva [or food] if the abnormal connection is not urgently ligated

We report a case of a neonate referred at three days of age where the nasogastric tube [NGT] had not coiled proximally as expected; the tube initially extended vertically to the level of the diaphragm, giving the impression of an intact esophagus. The neonate subsequently underwent primary repair of the atresia with fistula ligation. At five-months post-discharge follow-up, the patient was thriving and well