[The pediatric surgeon and acute appendicitis]. / Le chirurgien pédiatre et l'appendicite.

The management of acute appendicitis in the pediatric patient has undergone radical rethinking in recent years. It has been shown that simple uncomplicated acute appendicitis can be successfully managed with antibiotic therapy and may not even require interval appendectomy. Appendicitis complicated by perforation, abscess, or inflammatory phlegmon can be successfully treated by initial antibiotic therapy (with or without percutaneous drainage) and delayed interval appendectomy. While the laparoscopic approach has proved to be well-adapted to many other pediatric surgical procedures, its utility in the treatment of uncomplicated acute appendicitis remains open to debate; compared to standard open appendectomy, it offers only minimal advantages with regard to post-operative care, length of hospital stay, and complications. Children can be managed either by general surgeons or pediatric surgeons depending on the organization of the emergency service; there may be a higher incidence of removal of a normal appendix in non-specialized services.

[Age for testicular torsion?]. / Un âge pour la torsion testiculaire ?

UNLABELLED: Classically, testicular torsion occurs in neonates or during puberty. Between these two ages, is it really an exception? METHOD AND PATIENTS: In order to answer the question, we reviewed the charts of the patients referred to the department of pediatric surgery of Bicêtre hospital between 1992 and 2001. We studied the preoperative examinations, the operative data and the long term evolution. Cases of torsion occurring during neonatal or pubertal periods were excluded. RESULTS: During nine years, 86 patients with "acute scrotum symptoms" underwent surgery. The ages of patients ranged from one month to 11 years (average age: five years) in 26 patients, among which 12 had true testicular torsion. Consultation at the emergency room occurred after one to 72 hours (average of 17). The localization of the pain was on the left in eight cases and on ectopic testicle in two. The testicular volume was increased in 11 cases. Cremasteric reflex was absent in four cases. The doppler flow was normal in four cases and absent in four. During surgery, the testis appearance was considered as normal in six testicles, as necrotized in three (and an orchidectomy was performed) and as ischemic in three. In seven cases, a peroperative contralateral testicle fixation was performed and later one in two. The postoperative course was simple, without infection and with a normal testicular volume in eight cases, increased in one ischemic testis. Testicular atrophy was noted in an ischemic testis, after several months. CONCLUSION: Whatever the age, testicular torsion remains a surgical emergency even with a normal doppler flow.

[Epididymal cysts in adolescents]. / Les kystes de l'épididyme chez l'adolescent.

Epididymal tumours are uncommon in children and adolescents and are usually benign. Epididymal cyst is exceptionally reported in the literature, although it is certainly underdiagnosed. The authors report 3 cases of epididymal cyst in 3 children, 12, 14 and 16 years of age. These children presented with an uncomfortable scrotal mass and were treated by excision of the cyst in every case. The aetiology of epididymal cysts is unclear. It is probably a congenital abnormality related to hormonal disorders during embryonic life. Physical examination is very important, but not sufficient for the diagnosis and must be completed by scrotal ultrasonography, which shows an echo-free cystic epididymal structure. Despite ultrasonography, the differential diagnosis of other scrotal cystic masses and even some solid epididymal tumours, which may present all of the sonographic characteristics of a cyst, must be considered. The treatment of symptomatic epididymal cyst in children must be surgical. For asymptomatic cysts diagnosed by sonography, clinical follow-up to document stability of the mass is justified.