A Pediatric Case of Granulomatous Appendicitis Operated Due to Recurrent Abdominal Pain.

Granulomatous appendicitis (GA) is granulomatous inflammation of the appendix wall. It is generally idiopathic; however, it may also be associated with many diseases such as Crohn's disease, parasitic infections, tuberculosis, or foreign bodies. An 11-year-old male patient, with a 3-month history of abdominal pain and bilious vomiting, had right lower quadrant abdominal tenderness. His white blood cell count was 8.6 x103/µL. An abdomen ultrasound was considered to show plastron appendicitis and an appendectomy was performed. Microscopically, thickening of the appendix wall with edema, fibrosis and lymphoid infiltration was observed. The patient was evaluated as idiopathic GA since no disease was detected that caused GA. When the appendix has a firm consistency and is difficult to separate from the surrounding tissues, GA should be considered before malignancy, particularly in the pediatric age group. An appendectomy should be performed before deciding on radical surgery.

Can Ischemia-Modified Albumin Be a Helpful Marker in the Diagnosis and Follow-Up of Childhood Intussusception?

OBJECTIVES: Intussusception is the invagination of a proximal segment of the intestine into a more distal segment. The present study aimed to determine the sensitivity of the ischemia-modified albumin (IMA) and the correlation between IMA and the severity of intestinal ischemia in intussusception cases. METHODS: Thirty-six consecutive children aged between 0 and 16 years presenting with the clinical and radiological features of intestinal obstruction caused by intussusception were enrolled in the study. The age- and sex-matched control group was composed of patients undergoing outpatient surgery. The patients were categorized as cases of type I (ileoileal), type II (ileocecal), and type III (colocolic) based on the ultrasonography findings. RESULTS: The mean IMA level of the intussusception group was 179.13 ± 220.33 ng/mL, whereas the mean level was found as 89 ± 70.9 ng/mL in the control group. When the patients were categorized as ileoileal, ileocecal, and colocolic, the mean IMA levels were detected as 235.65 ± 268.14 ng/mL, 174.46 ± 212.8 ng/mL, and 46.95 ± 19.56 ng/mL, respectively. There was a moderate correlation between the invaginated segment lengths measured by the surgeon during the operation and IMA levels. CONCLUSIONS: Our study findings reveal that IMA can be used as an auxiliary diagnostic marker in patients presenting with symptoms and signs suggestive of intussusception. Thus, patients can be screened for mechanical bowel obstruction due to intussusception and may be referred to pediatric surgery centers earlier for further examination.

Evaluation of parental sociocultural background and education level in response to pediatric testis torsion.

INTRODUCTION: Acute scrotal pain (ASP) remains one of the most common male urologic emergencies in the pediatric age group. The most concerning outcome of testicular torsion (TT) is the need for orchiectomy, which has a negative impact on the child's development in general and on sexual development and psychology in particular. Time is the most important factor in the treatment of TT. Parental awareness of ASP indicating the possibility of TT is a significant factor in children's hospital admission time. Sociocultural background may be an indicator in parental awareness. OBJECTIVE: This study sought to determine if parental sociocultural and education level is associated with delayed treatment for TT. STUDY DESIGN: This retrospective study evaluated data for patients with scrotal or abdominal pain and TT at two hospitals in Konya, Turkey from 2012 to 2020. Study participants were the parents of the patients treated for TT. Participants were contacted by telephone and asked about their educational background. The study population was divided into 2 groups based on parent characteristics. Group 1 parents had an education level less than high school, had no health insurance, were in need of state aid, and had a low sociocultural background. Group 2 parents had an education level of at least high school or higher and had health insurance. Symptom duration (time between symptom onset and hospital admission) and surgical procedures for the patients were compared between the 2 parent groups. RESULTS: Of the 140 patients who received a diagnosis of TT, 77 were in Group 1 and 63 in Group 2. Mean patient age was 12.7 ± 2.7 (5-16) years Median symptom duration was 7 (1-120) hours. Symptom duration was higher in Group 1, but no statistically significant differences were noted between groups (Group 1 duration was 8h vs. Group 2 duration of 6h; p = 0.331). Orchiectomy was performed for 62 (44.3%) patients and testicular-sparing surgery for 78 (55.7%). Orchiectomy rates between groups were statistically significant and higher in Group 1 with 41 (53.2%) versus 21 (33.3%) in Group 2. CONCLUSION: Factors such as low sociocultural family background and low parental education level increase the risk of orchiectomy for their children. Awareness of the symptoms of TT may minimize the possibility of testicular loss.