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Simon D, Olive A. A Rare Cause of Acute Pediatric Right Lower Quadrant Abdominal Pain. J Pediatr Gastroenterol Nutr 2023; 76:e88. [PMID: 36917837 DOI: 10.1097/mpg.0000000000003776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- David Simon
- From the Division of Pediatric Gastroenterology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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Hatakeyama T, Okata Y, Miyauchi H, Hisamatsu C, Nakatani T, Nakai Y, Bitoh Y. Colonic diverticulitis in children: A retrospective study of 16 patients. Pediatr Int 2021; 63:1510-1513. [PMID: 33705582 DOI: 10.1111/ped.14693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric colonic diverticulitis (CD) is a rare entity. This study aimed to investigate the clinical features of CD in children. METHODS We performed a retrospective chart review of children aged ≤15 years who were diagnosed with CD in our institution from May 2006 to November 2016. RESULTS Sixteen patients were diagnosed with CD. All CD cases were observed to be solitary cecal diverticulitis; 14 cases were detected using ultrasound and the other two cases were diagnosed by computed tomography. Five patients were male (31.3%), and the median age was 12 years (range, 8-15 years). Initial symptoms were fever (temperature >38°C) in six (37.5%) patients, right lower quadrant abdominal pain in 16 (100%), anorexia in eight (50%), and nausea / vomiting in five (31.3%). A patient experienced persistent constipation; however, diarrhea was not observed as a clinical symptom in any patient. The median duration from symptom onset to admission was 1 day (range, 0-4 days), and the median length of hospital stay was 6 days (range, 4-10 days). All CD cases were treated with intravenous antibiotics. The median follow-up period was 90 months (range, 37-163 months), and during this period, recurrence of CD was observed in three (18.8%) patients. At recurrence, antibiotics were administered in all cases. CONCLUSIONS In this study, all cases of CD were solitary cecal diverticulitis, and ultrasound was useful for the diagnosis of cecal diverticulitis in children. Non-operative treatment should be recommended as an initial treatment for CD in children.
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Affiliation(s)
- Tadashi Hatakeyama
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Okata
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Harunori Miyauchi
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chieko Hisamatsu
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taichi Nakatani
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yumiko Nakai
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuko Bitoh
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Lee ZW, Albright EA, Brown BP, Markel TA. Congenital cecal diverticulitis in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 72. [PMID: 34422552 PMCID: PMC8372977 DOI: 10.1016/j.epsc.2021.101929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Diverticulitis in the pediatric population is a very rare cause of abdominal pain. When present in the cecum or ascending colon, it is often incorrectly diagnosed preoperatively as acute appendicitis. This is especially true in Western countries where right-sided diverticulitis is less common. Here we detail a case of a pediatric patient with complicated congenital cecal diverticulitis and review the literature on pertinent management. An extensive work up with imaging and endoscopy was completed and definitive surgical treatment with diverticulectomy an appendectomy was performed. As the incidence of diverticular disease in younger individuals increases, right sided diverticulitis is worthy of consideration on the differential diagnosis.
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Affiliation(s)
- Zachary W Lee
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric A Albright
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Brandon P Brown
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Troy A Markel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Ileocolic Intussusception secondary to caecal diverticulum in a 4-month-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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The Impact of Pathological Criteria on Pediatric Negative Appendectomy Rate. J Pediatr Surg 2019; 54:1794-1799. [PMID: 30685199 DOI: 10.1016/j.jpedsurg.2018.10.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/21/2018] [Accepted: 10/28/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Negative appendectomy rate (NAR) is a quality metric used in the surgical management of appendicitis. The rates of negative appendectomy (NA) in children range anywhere from 1% to 40% in the literature. Many reports do not provide clear pathological definitions for either appendicitis or NA on which they base their calculation of NAR. We reviewed our experience with pediatric appendectomy and the pathological spectrum encompassed within our definition of a NA and examined how the pathologic definition impacts our hospital's NAR. METHODS A retrospective review from 2012 to 2016 in a single institution identified 1676 children that underwent appendectomy. Average age was 11.4 (2-18 years). Patient demographics, clinical outcomes and pathological findings were collected. At our institution, appendicitis is defined as the presence of transmural acute inflammation in the appendix and those patients without this finding have been considered to have had a negative appendectomy. RESULTS 1435 patients underwent appendectomy for presumed appendicitis. The rate of pathologically diagnosed appendicitis was 91.1% (1307/1435) and as such, the NAR was 8.9% (128/1435). Review of the pathology of the NA cohort identified 67/128 (52.3%) patients with completely normal pathology. The remaining 61 patients displayed some sort of pathological abnormality including malignancy (n = 2), fecaliths (n = 9), pinworms (n = 3), granuloma (n = 2), fibrous obliteration (n = 4), isolated periappendiceal inflammation (n = 1), and acute inflammation confined to the mucosa (n = 40). Exclusion of these patients with abnormal pathology decreased the NAR to 4.6%. Patients with pathological abnormalities of the appendix other than transmural inflammation had a higher rate of 30-day readmission than patients with acute appendicitis (8.2% versus 4.5% p < 0.01). CONCLUSION Pediatric NAR is dependent upon the pathological definition of appendicitis and negative appendectomy. Institutional variation in definition may explain discrepancies in the literature. By example, including only those that show "the absence of inflammation or other appendiceal pathology" would decrease our NAR by 50%. This study calls into question the interpretation of interhospital NAR and the use of NAR as a quality metric in the management of appendicitis. Retrospective comparative study: Level III evidence.
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