Under hepatic appendicitis complicated by peritonitis and under hepatic abcess - about a case report

Appendicitis in the child under 3 years old is rare and often arises in a serious and complicated form considering the delay of diagnosis. Its localization is sometimes ectopic and the clinical signs are often misleading. The diagnosis primarily rests on the clinical examination. Abdominal echography and the tomodensitometry are reserved for the diagnostic doubts, we bring back the observation of a 2 year and 9 months old girl which consulted for acute abdominal pain, fever and stop of the matters. The clinical examination showed an abdominal distension with diffuse sensitivity. Abdominal echography was normal. The biological exams objectivated an hyperleucocytosis with polynucleosis. The patient was kept under surveilance the evolution was done towards the persistence of the fever and the installation of a liquid diarrhoea making carry the diagnosis of acute gastro-enteritis. After 5 days of hospitalization, apparition of an abdominal defense generalized with saddles striated with blood the abdomen radiography showed grelic hydroaeric levels and echography revealed the presence of an under hepatic collection. The post-operative evolution was good. In the light of this observation, the authors make a review of the literature while insisting on the diagnostic difficulties of appendicites of the child

cystic dilatation of choledoque. A case report

The cystic dilation of choledoque is a rare congenital affection. It represents the first cause of extra hepatic cholestase in child. The discovery is generally made in childhood. The diagnosis rests primarily on echography. Because of the secondary risk of degeneration of the cyst and its complications, the complete surgical resection is essential. We report the case of an infant of female sex admitted in our service at the age of 11 months for abdominal distension, fever, icter and melena. The clinical examination found an supra-umbilical mass. Radiological explorations [echography, scanner and IRM] were in favour of a pseudo cyst of the choledoque. The treatement consisted on an exeresis of the cyst followed with bilio-digestive and ilio-jejunal anastomosis. The post-operative evolution was simple. At the occasion of this observation, the authors make a review of literature