Retraction: New Criteria Could Improve the Success Rate of Non-operative Management of Acute Appendicitis in Children.

[This retracts the article DOI: 10.7759/cureus.25857.].

Laparoscopic appendectomy: Effectiveness in children with generalized and advanced generalized peritonitis cases.

Laparoscopic appendectomy is one of the most common surgical procedures in treating pediatric appendicitis. This study aimed to investigate the efficacy of laparoscopic surgery in cases complicated with advanced generalized peritonitis in the pediatric population. The study retrospectively reviewed 55 cases of children who underwent laparoscopic appendectomies. The cases were classified as uncomplicated, complicated, or advanced generalized peritonitis. Laboratory results, diagnostic algorithms, surgical techniques, and complications were investigated. Twenty-four of the cases were boys and 31 were girls. Mean age was 11.3 ± 3 years. Twenty of the cases (36%) were uncomplicated and 35 (64%) were complicated. Nine of the complicated cases presented advanced generalized peritonitis and were additionally classified as "another special group". Mean leukocyte count and C-reactive protein levels were measured respectively as 22.49 ± 12 x 109 /L and 120.5 ± 99 mg/L in complicated cases and as 17.06 ± 10 x 109 and 52.37 ± 69 mg/L in uncomplicated cases. All advanced generalized peritonitis cases had presented to the hospital with intestinal obstruction and had diffuse abdominal rigidity on physical exam. None of the cases had any complications in the intraoperative or early postoperative period. Infection complications (namely, intra-abdominal abscesses and surgical site infections) were observed in four cases (7%) in the postoperative period. Mean length of hospital stay was 5.62 ± 2.6 days and 3.95 ± 1 days in complicated and uncomplicated cases, respectively. Mean length of stay in advanced generalized peritonitis cases was 8.33 ± 2 days. It was observed that laparoscopic appendectomy might be the first choice of treatment option in cases complicated with advanced generalized peritonitis.

New Criteria Could Improve the Success Rate of Non-operative Management of Acute Appendicitis in Children.

BACKGROUND: Most studies addressing non-operative management for acute appendicitis have focused on adults, and there are limited data available for children. We aimed to evaluate the results of successful non-operative management in children with acute uncomplicated appendicitis with our "additional criteria" and find which factors could be affecting the success rate and which cases could be candidates for non-operative management. MATERIALS AND METHODS: A total of 54 patients who were diagnosed with acute uncomplicated appendicitis and received non-operative management were re-evaluated retrospectively. Defining uncomplicated appendicitis was based on the duration of symptoms (<24 hours), clinical history, and radiologic findings. The radiologic evaluation was based on ultrasonography and computed tomography. The patients received an intravenous antibiotic combination (sulbactam/ampicillin, gentamicin, clindamycin) for five days at the hospital; the treatment was completed after 10 days with an oral antibiotic combination (amoxicillin/clavulanate, metronidazole). The cases have a follow-up period of up to two years. RESULTS: The mean patient age and follow-up time were 13.0 ± 4 years and 41.6 ± 13 months, respectively. The mean leukocyte count, C-reactive protein (CRP), and appendix diameter values were 15.48 ± 6.4 × 109/L, 11.79 ± 24.5 mg/dL, and 7.76 ± 1.4 mm on admission, and 6.86 ± 12.4 × 109/L, 4.17 ± 10.3 mg/dL, and 5.82 ± 1.6 mm on the second day, respectively. This decrease in WBC/CRP values and appendix diameter was statistically significant (p < 0.001). None of the patients had an early failure, complication, or adverse event. Recurrent appendicitis occurred in only five cases (9%) that were treated by laparoscopic appendectomy during the follow-up. CONCLUSION: Non-operative management for acute uncomplicated appendicitis in children regarding long-term outcomes with our criteria was satisfactory and initial success rates were excellent.

Using Machine Learning Technique to Predict the Most Reliable Diagnostic Finding for Foreign Body Aspiration in Children: Symptoms, Chest X-ray, or Auscultation?

Foreign body aspiration (FBA) is one of the most critical and life-threatening pediatric emergency situations. Prompt diagnosis in these cases is very important as they are associated with high mortality among children. When diagnosing FBA, symptoms of the patient, auscultation findings, and chest X-ray findings are usually evaluated. In this study, we conducted a retrospective analysis of all the cases involving suspicion of FBA in children under the age of 18 years who were hospitalized in the Department of Pediatric Surgery at Denizli Pamukkale University Hospital, Turkey from January 2005 to September 2020. Instead of traditional statistical methods, we used machine learning techniques such as random forest and logistic regression to determine which finding was diagnostically the most reliable. The variables included in the analysis that were considered to be significant were as follows: symptoms, auscultation findings, chest X-ray findings, patient gender, age, location of the foreign body, and the time of admission. For the purpose of this study, we developed four different models. Model 1 included gender, age, time of admission, location, and symptoms as variables; the correct classification rate of the model was found to be 82.3%. Model 2 included auscultation findings in addition to Model 1, and the correct classification rate of the model was 84.8%. Model 3 included chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.4%. Model 4, on the other hand, included both auscultation findings and chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.6%. Based on our findings, a definitive diagnosis of FBA using only symptoms, auscultation findings, or chest X-ray findings in isolation does not seem possible. Additionally, using only symptoms and chest X-ray findings is also insufficient to make a diagnosis.

Esophageal button battery ingestion in children.

BACKGROUND: Button battery lodged in the esophagus carries a high risk of morbidity and mortality. The purpose of this study was to present cases of patients with esophageal button battery ingestion treated at our clinic and to emphasize the importance of early diagnosis and treatment. METHODS: Records of patients admitted to our hospital for foreign body ingestion between January 2010 and May 2015 were retrospectively reviewed. Cases with button battery lodged in the esophagus were included in the study. Patient data regarding age, sex, length of time after ingestion until admission, presenting clinical symptoms, type and localization of the battery, management, and prognosis were analyzed. RESULTS: Among 1891 foreign body ingestions, 71 were localized in the esophagus, and 8 of those (11.2%) were cases of button battery ingestion. Mean age was 1.7 years. Admission was within 6 hours of ingestion in 5 cases, after 24 hours had elapsed in 2, and 1 month after ingestion in 1 case. All patients but 1 knew the history of ingestion. Prompt endoscopic removal was performed for all patients. Three patients developed esophageal stricture, which responded to dilatation. CONCLUSION: Early recognition and timely endoscopic removal is mandatory in esophageal button battery ingestion. It should be suspected in the differential diagnosis of patients with persistent respiratory and gastrointestinal symptoms.

Intralesional bleomycin sclerotherapy in childhood lymphangioma.

This clinical trial was conducted to evaluate the efficacy of intralesional bleomycin sclerotherapy (IBS) in children with lymphangioma and to determine the incidence of complications in the treatment. Seventeen lymphangioma cases were treated with IBS from 2004 to 2012. Age, mode of presentation, locations and types of lesions, and results of treatment were studied. Lymphangioma was diagnosed by physical examination and imaging studies. Most of the lesions were located in the cervical region (n=8) and of macrocystic type (n=13). After the first injection, three patients were lost to follow-up. Good response was seen in 50% of the lesions, complete resolution in 35.7%, and poor response in 14.3%. No serious complications or side effects were observed after IBS. The average follow-up was 18.5 months. IBS is effective in the treatment of lymphangioma. Although no major adverse effects have been encountered, complications should be kept in mind and in the event of their occurrence be treated immediately.

Management of epididymal cysts in childhood.

BACKGROUND: A retrospective review was carried out to evaluate the clinical presentation of children with epididymal cysts (EC) and outcome of management at our institution. METHODS: There were 49 patients with EC in this series. The diagnosis of EC was made by physical examination and confirmed by ultrasound (US). RESULTS: The average age at presentation was 10.7 years (2 months-16 years). Scrotal mass (n: 22) and pain (n: 21) were the most frequent symptoms. Seven patients were lost to follow-up. The cysts were solitary in 32 patients and multiple in 10 patients. The mean value of cysts was 6.7 mm (2-20 mm). The cyst localisations were 22 in left, 16 in right, and bilateral in 4 patients. Complete involution of cysts was detected in 14 children. The average involution time was 11.2 months (1-37 months). In 20 cases, a decrease in cyst size was found. Cyst excision was performed in 8 patients with persistent scrotal pain or no cyst involution observed during follow-up. CONCLUSION: Conservative management of epididymal cysts is practical. However, surgical excision is recommended in patients with intractable scrotal pain or if the cyst size does not seem to involute.

Treatment of acute scrotum in children: 5 years' experience.

BACKGROUND: A retrospective review was carried out to determine the incidence of various causes and outcome of management in patients with acute scrotum. METHODS: Fifty children had a diagnosis of acute scrotum between 1st January 2007 and 15th May 2012. Age, mode of presentation, associated anomalies, and results of treatment were studied. Diagnosis of acute scrotum was confirmed by physical examination, Doppler ultrasound and biochemical investigations. RESULTS: Clinical presentation consisted of sudden swelling and pain in the inguinoscrotal region. The average age was 7.5 years (2 months-14 years). Causes of acute scrotum were orchitis/epididymo-orchitis (O /EO) in 22, strangulated inguinal hernia (SIH) in 16, testicular torsion (TT) in 11, and torsion of testicular appendage (TTA) in 1. Associated urological anomalies were found in 5 patients with O /EO. Medical treatment was applied to patients with O /EO, and surgical treatment was performed in patients with SIH, TT and TTA. CONCLUSION: In this series, O /EO was found to rank first as the cause of acute scrotum. Immediate surgical treatment in acute scrotum patients, except those with O /EO, is necessary. Associated urological anomalies should be investigated in patients with O /EO.