A 2-year-old with a hepatic abscess secondary to an ascending retrocecal appendicitis: case report and review of the literature.

BACKGROUND: Diagnosing appendicitis within the pediatric population can be challenging, whether it be a neonate with irritability or a toddler with flank pain. Symptoms may mimic a viral illness, constipation, urinary tract infection, or intussusception, all of which are more common in this age group when compared with appendicitis. While a ruptured appendicitis can result in an intra-abdominal abscess, peritonitis, and/or shock, the development of a pyogenic hepatic abscess is extremely rare. CASE PRESENTATION: We present the case of a 2-year-old male who initially presented to the emergency department (ED) with fever and non-specific abdominal pain and was diagnosed with a urinary tract infection (UTI). He returned to the ED days later with rigors, worsening abdominal pain, and was diagnosed with a pyogenic hepatic abscess secondary to an ascending retrocecal appendicitis. In our patient, he did not just have a UTI with cultures growing Escherichia coli, but a hepatic abscess that was polymicrobial. He was started on broad-spectrum antibiotics and a 10 French pigtail catheter was placed. The patient was ultimately discharged on day 8 with continued antibiotics. After his antibiotic course, he underwent an elective laparoscopy appendectomy and is currently doing well post-operatively. CONCLUSION: Our case report illustrates the significance in identifying atypical features of appendicitis, broadening the differential of non-specific abdominal pain in pediatric patients, and depending on the clinical situation, ruling out other potential intra-abdominal infections even in the presence of a true urinary tract infection.

A comparison of head injuries in male and female lacrosse participants seen in US emergency departments from 2005 to 2016.

INTRODUCTION: In the United States there has been a large increase in participation in lacrosse for both males and females. The purpose of this study was to analyze the number of head injuries, injury rates (calculated using the reported number of participants) and types of head injuries that are seen in emergency departments in the United States. METHODS: We compared injuries between male and female lacrosse participants. This was a retrospective study using a publicly available database produced by the US Consumer Product Safety Commission and information about lacrosse participation from US Lacrosse. RESULTS: A linear regression was performed and showed a positive correlation between number of head injuries to males and time from 2002 to 2010 (R2 = 0.823; p = 0.001). While the number of injuries to the head in female lacrosse participants was not significant. There was a negative correlation between the number of head injuries to males from 2010 to 2016 (R2 = 0.800; p = 0.007), but again, there was no significance for female injury count (R2 = 0.417; p = 0.117). Other significant differences between head injuries in males and females included the mechanism of injury and the type of injury recorded. CONCLUSION: The most recent data from 2010 to 2016, suggest that both males and females have had a decrease in injury rate. However the total number of female head injuries is not significantly decreasing and as the sport continues to grow there will likely be more total head injuries and visits to the emergency department.