ABSTRACT
Ovarian torsion (OT) in the pediatric patient is an uncommon event and a challenging diagnosis. Clinicians caring for children in the acute setting should be aware of the symptoms and the diagnostic findings of OT. All patients suspected to have OT require consultation with gynecology; however, there is some controversy regarding the best operative intervention. In this article, case discussions will serve as a platform for discussing the epidemiology and clinical manifestations of pediatric OT, as well as reviewing the latest evidence related to the diagnosis and treatment.
Subject(s)
Abdominal Pain/diagnosis , Laparoscopy/methods , Ovarian Diseases/diagnosis , Ovary/pathology , Torsion Abnormality/diagnosis , Abdominal Pain/surgery , Adolescent , Diagnosis, Differential , Female , Humans , Ovarian Diseases/epidemiology , Ovarian Diseases/surgery , Torsion Abnormality/epidemiology , Torsion Abnormality/surgeryABSTRACT
OBJECTIVES: The objective was to assess the performance of a clinical practice guideline for evaluation of possible appendicitis in children. The guideline incorporated risk stratification, staged imaging, and early surgical involvement in high-risk cases. METHODS: The authors prospectively evaluated the clinical guideline in one pediatric emergency department (ED) in a general teaching hospital. Patients were risk-stratified based on history, physical examination findings, and laboratory results. Imaging was ordered selectively based on risk category, with ultrasound (US) as the initial imaging modality. Computed tomography (CT) was ordered if the US was negative or indeterminate. Surgery was consulted before imaging in high-risk patients. RESULTS: A total of 475 patients were enrolled. Of those, 193 (41%) had appendicitis. No low-risk patient had appendicitis. Medium-risk patients had a 19% rate of appendicitis, and 83% of high-risk patients had appendicitis. Factors associated with an increased likelihood of appendicitis included decreased bowel sounds; rebound tenderness; and presence of psoas, obturator, or Rovsing's signs. Of the 475 patients, 276 (58%) were managed without a CT scan. Seventy-one of the 193 (37%) patients with appendicitis went to the operating room without any imaging. The rate of missed appendicitis was 2%, and the rate of negative appendectomy was 1%. CONCLUSIONS: The clinical practice guideline performed well in a general teaching hospital. Rates of negative appendectomy and missed appendicitis were low and 58% of patients were managed without a CT scan.
Subject(s)
Appendicitis/diagnosis , Practice Guidelines as Topic , Risk Assessment/methods , Abdominal Pain/etiology , Acute Disease , Adolescent , Appendicitis/diagnostic imaging , Appendicitis/surgery , Child , Emergency Service, Hospital , Humans , Prospective Studies , Tomography, X-Ray Computed , UltrasonographyABSTRACT
In recent years, gallbladder disease, primarily in the form of cholelithiasis, has been on the rise among infants and children. Although pediatric gallbladder disease is still less prevalent than adult gallbladder disease, physicians and other clinicians who care for children need to be aware of this underappreciated problem and understand the manifestations of biliary disease in the pediatric population. In this article, case discussions will serve as a platform for discussing the clinical spectrum of cholelithiasis and its complications in children as well as discussing the latest evidence related to diagnosis and treatment.
