ABSTRACT
AIM OF THE STUDY: To describe the clinical, surgical, and pathological features of children with acute appendicitis and amebiasis. MATERIALS AND METHODS: The medical records of children diagnosed with appendicitis and amebiasis treated at Fundación Hospital la Misericordia were retrospectively reviewed. Patients were classified into two groups according to the location of the amoebas: the amoebic appendicitis (AA) group (when the amoebic infection involved the appendiceal wall), and the appendicitis with incidental amoebiasis (IA) group (when amoebas were only found in the appendiceal lumen). We compared demographics and outcomes. RESULTS: We identified 23 children with appendicitis and amoebiasis. The mean age was 9 (3-15) years, and 52% were male. The main duration of the pain at the time of presentation was 1.8 (1-4) days. Fever and diarrhea were observed in 64% and 43% of the patients, respectively. Four patients had perforated appendicitis, all of them within the AA group. Anti-parasitic therapy was used only in 2 subjects (all other patients were diagnosed after discharge and were asymptomatic on follow up). AA was diagnosed in 11 patients and IA in 12. AA and IA patients shared similar characteristics regarding age, clinical findings, radiologic features, and preoperative laboratory results. Appendiceal necrosis and perforation were only found within the AA group (4 patients). CONCLUSIONS: AA is a rare condition in children. It seems to have a greater risk of perforation than cases of appendicitis with IA, which is in agreement with the more severe histological findings in our series. Anti-parasitic treatment is not necessary in cases of AA or IA.
Subject(s)
Appendicitis , Appendix , Enterocolitis , Acute Disease , Adolescent , Appendectomy , Appendicitis/diagnosis , Appendicitis/surgery , Child , Humans , Male , Retrospective StudiesABSTRACT
Abstract Introduction: Appendicitis can be classified as non-perforated and perforated; based on such classification, the reported organ-space surgical site infection (OS-SSI) rate is 0.8% and 18%, respectively. Objective: To establish the prevalence of OS-SSI in patients with perforated appendicitis treated in a pediatric hospital in 2012. Materials and methods: Retrospective, observational and descriptive study conducted at Fundación Hospital Pediátrico La Misericordia, with a random sample of200 patients, ofwhich 160 met the inclusion criteria. Results: 20 patients (12.5%) presented with OS-SSI and all of them received antibiotic treatment; 70% did not require abscess drainage. Patients ≥8 years of age had 5 times more abscesses than younger ones (17.6% vs. 3.4%). OS-SSI was found in 33% of patients with free fecalith and in 50% of the patients who required postoperative management at the ICU vs. 9.5% of the patients who received management in the intermediate care unit and the inpatient hospital floors. The total rate of surgical site infection was 24.3% (11.8% superficial, 0% deep and 12.5% organ-space). Conclusions: The prevalence of OS-SSI found here is lower than what has been reported in the literature. Being 8 years or older and having free fecalith are risk factors to develop this type of infection. The higher frequency of OS-SSI in patients treated at the ICU during the post-operative period observed here suggests that this condition may be associated with septic shock.
Resumen Introducción. La apendicitis se clasifica en no perforada y perforada; de acuerdo a esta clasificación, la tasa de infección del sitio operatorio órgano-espacio (ISO-OE) es de 0.8% y 18%, respectivamente. Objetivo. Determinar la prevalencia de ISO-OE en pacientes con apendicitis perforada en un hospital pediátrico en 2012. Materiales y métodos. Estudio retrospectivo y observacional descriptivo de corte transversal. La muestra fue aleatoria y de 200 pacientes, 160 cumplieron los criterios de inclusión. Resultados. Los 20 pacientes (12.5%) que presentaron ISO-OE recibieron manejo antibiótico; 70% no requirió drenaje de colección. Los pacientes ≥8 años presentaron 5 veces más ISO-OE (17.6% vs. 3.4%). El 33% de los pacientes con fecalito en cavidad y el 50% que se hospitalizó en post-operatorio inmediato en la unidad de cuidados intensivos (UCI) desarrollaron ISO-OE versus 9.5% de los pacientes atendidos en la unidad de cuidados intermedios y pisos. El total de ISO fue 24.3%: 11.8% superficial, 0% profunda y 12.5% de órgano-espacio. Conclusiones. La prevalencia de ISO-OE encontrada es menor a la reportada en la literatura. La edad ≥8 años y el fecalito en cavidad son factores de riesgo para desarrollar este tipo de infección. La mayor frecuencia de ISO-OE en pacientes manejados en el posoperatorio en UCI sugiere que esta condición puede estar asociada con el choque séptico.
ABSTRACT
Introduction: Minimally invasive surgery (MIS) in pediatric surgery is now the standard of care for various surgical conditions. We have seen an increase in MIS with some of the procedures requiring intraoperative conversion to open surgery. Materials and Methods: This is a single-institution retrospective study of patients who underwent MIS between 2009 and 2017 requiring conversion to open surgery. Preoperative characteristics, cause of conversion, and postoperative factors were recorded. Results: A total of 154 patients had converted to MIS, 89.6% underwent laparoscopic procedures. Mean age was 8.5 years, 53.9% were male. Primary cause leading to surgery was not oncologic (89.6%), dirty contaminated wound was found in 49.35%, inflammatory response markers were altered, and 38.9% of our patients were American Society of Anesthesiologists physical status classification 3. Principal causes of conversion were failure in progression (53.25%) and loss of anatomic reference (24.5%). A total of 44.16% of the patients required postoperative pediatric intensive care unit admission, 29.2% required reintervention, and mortality rate was 0.65%. We detailed data regarding thoracoscopic, appendectomy, and laparoscopic procedures. Conclusion: Conversion to MIS is a decision the surgeon must make in different scenarios. This study allowed us to characterize our population regarding converted MIS procedures. Male gender, age group, altered inflammatory markers, not oncologic pathology, and dirty wound were frequently found, but we cannot establish any of them as risk factors. Main cause for conversion to open surgery was failure in the progression of the procedure in our study according to reported literature. We intend to develop further studies to determine risk factors.
Subject(s)
Conversion to Open Surgery/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Laparoscopy/statistics & numerical data , Minimally Invasive Surgical Procedures/methods , Adolescent , Child , Child, Preschool , Female , Humans , Male , Retrospective StudiesABSTRACT
Se analizaron las 1326 muertes por causa externa (accidentes, suicidios y homicidios) registradas en el Instituto de Medicina Legal de Cali, durante todo el ano de 1985 y las 777 muertes de enero 1 a junio 30, 1986. La tasa total de muertes violentas fue 92.5 por 100 mil habitantes y las tasas de homicidios y accidentes fueron 57.6 y 30.9 por 100000 respectivamente. Se encontro una relacion h/m de 7 a 1 en el total de muertes violentas. Una comparacion con un estudio similar realiazdo en Cali en 1965-1968, muestra que la elevacion en las muertes violentas se debe principalmente al aumento de casi 4.5 veces en las tasas de homicidios. Las muertes violentas se han constituido en las principales causas de muerte en Cali y en otras ciudades colombianas, hecho que contrasta con la poca importancia y la baja percepcion social que se brinda al problema
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Wounds and Injuries/epidemiology , Accidents , Colombia , Homicide , Suicide , Wounds and Injuries/classification , Wounds and Injuries/mortalityABSTRACT
Con el fin de conocer el comportamiento de las muertes por accidentes, suicidios y homicidios durante 1986 y 1987 con relacion a un estudio previo del ano 1985, se analizaron las 1512 muertes por causa externa registradas en el Instituto de Medicina Legal de Cali, durante todo el ano de 1986 y las 1170 muertes de enero 1 a diciembre 31 de 1987. La tasa de homicidios 44.6 por 100,000 habitantes en 1987 fue la mas baja de las observadas durante los 3 anos de estudio; sin embargo, es todavia 3 veces mas alta que la informada para 1967. Los accidentes de transito no mostraron fluctuaciones importantes. Las muertes por accidentes de trabajo presentaron tasas en ascenso de 0.8 a 2.0 por 100,000 habitantes. Se observa que el grupo de edad de 15-44 anos sigue siendo el mas afectado por los homicidios y accidentes de transito; los suicidios, aunque con una tasa considerablemente menor en magnitud, presentaron un incremento en el riesgo de mortalidad con la edad. Al parecer 1986 fue un ano excepcionalmente violento en Cali, Colombia, que mostro una tasa de mortalidad bastante mas elevada que en los anos inmediatamente anterior y posterior
