ABSTRACT
AIM: Based on our experience with acute idiopathic scrotal oedema (AISO) and observations of the incidence of intestinal worm infestation (IWI), we decided to test the hypothesis that IWI occurs more frequently among children with AISO than it does in the general population. METHODS: A retrospective questionnaire-based study was conducted comparing the frequency of IWI between children who had AISO and a matched control group who had inguinal hernia surgery in our Pediatric Surgery Department during 2003-2009. This second group was chosen to represent the incidence of IWI in the paediatric community in our region. Records of all patients admitted to the Department of Pediatric Surgery for AISO during 2003-2009 were reviewed. RESULTS: Seventeen out of thirty-eight (44.7%) AISO patients had a history of IWI compared with 5/38 (13.1%) in the control group (P= 0.0047). CONCLUSIONS: Our data clearly show that AISO in children is frequently associated with a history of IWI. Although well-documented, prospective studies are needed to establish these findings, we feel that this report provides a reasonable clue to a possible aetiology of AISO.
Subject(s)
Edema/etiology , Intestinal Diseases, Parasitic/complications , Scrotum/pathology , Acute Disease , Animals , Child , Child, Preschool , Edema/diagnosis , Humans , Male , Retrospective Studies , Surveys and QuestionnairesABSTRACT
PURPOSE: Early ultrasound (US) evaluation of children with abdominal pain and suspected acute appendicitis (AA) is an important diagnostic tool. Since 2007, US has become part of routine emergency room (ER) work-up performed for suspected pediatric AA in our hospital. METHODS: We retrospectively compared hospital admissions from 2007 to 2008 with those from 2005 to 2006, when most ultrasounds were done after admission to Pediatric Surgery for observation. RESULTS: During the study (2005-2008), 6,511 children came to the ER with acute abdominal pain. Although pediatric ER sonography increased from 28.1% (865/3,079) in 2005-2006 to 51.7% (1,775/3,432) in 2007-2008 (p < 0.0001), hospitalizations decreased from 33 to 30.1% (p = 0.011). Concurrently, ER US for AA increased from 20.8% (639/2,440) to 38.9% (1,336/2,096) (p < 0.0001), admissions for suspected AA decreased from 51.8% (331/639) to 42% (561/1,336) (p < 0.0001). CONCLUSIONS: Sonography led to a significant decline in admissions and better selection of patients who required surgery for AA. Recurrent ER referrals for the same complaint within 2 weeks was very low (2.9%) with no difference between the two study periods (p = 1); none had AA. These findings encourage us to continue early US in children with suspected AA. This effective tool decreases unnecessary hospital stays, investigative procedures, and surgery, while reducing costs.
Subject(s)
Appendicitis/diagnostic imaging , Adolescent , Child , Child, Preschool , Early Diagnosis , Female , Humans , Infant , Male , Patient Admission/statistics & numerical data , Retrospective Studies , Time Factors , UltrasonographyABSTRACT
The pre-operative diagnosis of acute appendicitis (AA) has markedly changed during the last couple of decades due to the advent of modern imaging technology. Nowadays, the use of imaging has dramatically changed the way we approach children admitted to emergency room for abdominal pain with suspected AA. This change is mainly manifested in our diagnostic strategy.
Subject(s)
Appendicitis/diagnosis , Diagnostic Imaging/standards , Practice Guidelines as Topic , Acute Disease , Adolescent , Appendectomy , Appendicitis/surgery , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Imaging/methods , Female , Follow-Up Studies , Humans , Male , Reproducibility of Results , Retrospective StudiesABSTRACT
BACKGROUND/PURPOSE: Preoperative sonographic studies of the groins have become a routine evaluation of inguinal hernia in children. Its value is not only to confirm the clinical diagnosis, but also to accurately assess the opposite side and to prevent an unnecessary exploration or additional operation at a later stage. The purpose of this study is to report more definitive criteria of inguinal hernias (IH) and patent process vaginalis (PPV) established from 1,284 groin examinations. METHODS: From January 1999 to October 2000 the authors compared prospectively the sonographic dimensions of the inguinal canal to the operative findings as reported by the surgeons (blinded to the results) for 642 pediatric patients (ages 1 to 176 months) undergoing inguinal hernia repairs. RESULTS: A normal inguinal canal was found at operation when a preoperative sonographic groin width of 3.6 +/- 0.8 mm, on average, was detected. A PPV was found when a groin width of 4.9 +/- 1.1 mm was detected. A full hernia was found when a groin width of 7.2 +/- 2.0 mm was detected. A large hernia was found when a groin width of 12.8 +/- 3.6 mm was detected, and a hydrocele was found along with a groin width of 4.8 +/- 2.2 mm. CONCLUSIONS: Establishing accurate sonographic criteria for inguinal hernia and patent processus vaginalis is an important tool for the pediatric surgeon to plan the approach before groin surgery.
