ABSTRACT
We report an unusual case of a 3-year-old child with appendicitis complicated by ileoileal intussusception. Although acute complicated appendicitis and concurrent ileoileal intussusception represent a possible cause of an acute abdomen, very few cases have been reported in the literature.
Subject(s)
Appendicitis/complications , Ileal Diseases/etiology , Intestine, Small/diagnostic imaging , Intussusception/etiology , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Anti-Bacterial Agents/therapeutic use , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/surgery , Child, Preschool , Follow-Up Studies , Humans , Ileal Diseases/diagnostic imaging , Ileal Diseases/surgery , Intestine, Small/pathology , Intussusception/diagnostic imaging , Intussusception/surgery , Laparotomy/methods , Male , Postoperative Care/methods , Risk Assessment , Treatment Outcome , Ultrasonography, DopplerABSTRACT
Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gram-negative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.
