Search

Objectives This study aimed to investigate diagnostic value of monocyte-to-lymphocyte ratio as a novel biomarker in children with appendicitis and to compare with other biomarkers. Methods A total of 683 children were included in this retrospective study. Patients were categorized as acute appendicitis (AA, n = 254), perforated appendicitis (PA, n = 82), nonspecific abdominal pain (NAP, n = 197), and control (n = 150). The groups were compared for demographics, duration of symptoms, monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), white blood cell count, neutrophil percentage (NP), C-reactive protein (CRP), mean platelet volume, and sodium level. Results There was a significant difference between all groups for MLR, PLR, and CRP. White blood cell count, NP, and NLR were significantly increased in patients with appendicitis, but there was no significant difference in the differential diagnosis between PA and AA. Sodium levels significantly decreased in patients with appendicitis. No statistically significance was determined between all groups in term of mean platelet volume. Among the biomarkers, MLR showed the highest diagnostic value (area under the receiver operator characteristic curve = 0.798) for AA, while CRP showed excellent diagnostic value (area under the receiver operator characteristic curve = 0.897) for PA. Conclusions To our knowledge, this is the first study showing that MLR is a valuable parameter to differentiate patients with and without appendicitis. White blood cell, NP, and NLR are also useful parameters. On the other hand, an increased CRP level and hyponatremia are indicators of PA.

Exstrophic rectal duplication and its association with bladder exstrophy and anorectal malformation is an extremely rare clinical entity. This is a report of the second case of an exstrophic rectal duplication associated with bladder exstrophy in English literature. However, it is the first case, where all these anomalies were accompanied by an anorectal malformation.

Background:Appendicitis is one of the most common surgical emergencies. Early diagnosis of appendicitis is important in children because any delay in treatment substantially leads to complicated appendicitis. In this study, we aimed to test the diagnostic value of pentraxin 3 (PTX3) level in children with acute appendicitis and to investigate whether there is a relationship between the progression of the disease and PTX3 level.Methods:This prospective study included 70 children. They were divided into three groups as follows: group 1 (appendicitis; n=37), group 2 (abdominal pain; n=25), group 3 (control; n=8). Demographic data, medical history, the time from the onset of symptoms to blood sampling, operative and pathological findings of the patients were noted, and white blood cell (WBC), C-reactive protein (CRP) and PTX3 values were measured.Results:The mean WBC, CRP and PTX3 values were found to be significantly increased in the appendicitis group (pConclusion:This study showed that PTX3 is a valuable inflammatory biomarker in the diagnosis of acute appendicitis and also documented that PTX3 is useful for predicting the progression of the disease.

Background This study aimed to investigate whether there are some differences between pediatric and adult patients with appendicitis. Methods We retrospectively reviewed the records of 279 pediatric and 275 adult patients with respect to demographics, past medical history, duration of symptoms, laboratory and radiological findings, operation notes, pathological reports, length of hospital stay and post-operative outcomes. Results No significant differences were found with respect to gender, rates of perforation and negative appendectomy, laboratory findings, and overall outcomes between children and adults. However, our study suggests that the diagnosis is more difficult in children, the most preferred radiologic diagnostic methods are abdominal ultrasound and plain X-ray in children vs. computed tomography in adults, air-fluid levels and right-sided scoliosis are more commonly detected on X-ray in children, appendiceal perforation is more common at both extreme of ages, the appendix is perforated earlier and length of hospital stay is longer in children, and misdiagnosis at first admission in children and advanced age in adults were the risk factors associated with the complications. Conclusion The present study found some important differences between childhood and adulthood appendicitis. If these differences are considered when evaluating the patients, more desired outcomes can be achieved for both clinicians and patients.

Iatrogenic urethral foreign bodies are rare conditions in clinical practice, and the relevant data are limited to adult cases in the literature. In this paper, we presented a pediatric case in which a fragment of Foley catheter balloon remained in the posterior urethra.

Pneumoperitoneum is rarely encountered as a radiographic finding in association with perforated appendicitis in children, and may lead to diagnostic errors. In this paper, we present pneumoperitoneum as a presenting finding of perforated appendicitis in a 2-year-old boy. The term pneumoperitoneum frequently indicates perforation of an intra-abdominal hollow viscus. However, it is rarely encountered as a radiographic finding in association with perforated appendicitis. The cases reported in the literature are mostly adult patients, but the relevant data in children are limited. Here, we present a case of a 2-year-old boy with perforated appendicitis who presented with pneumoperitoneum. The patient was taken into the operation theater with an initial diagnosis of gastrointestinal perforation. Surgical exploration indicated a perforated appendix and an appendectomy was performed. Appendicitis is one of the most common surgical abdominal emergencies in children. However, very young children often pose a diagnostic dilemma for the clinician. Pneumoperitoneum is a confusing finding in perforated appendicitis, and may lead to diagnostic errors. However, it may be considered as a favorable sign because it will result in the patient’s immediate surgical exploration and cure. Keywords : appendicitis, children, pneumoperitoneum

Aim: The aim of this study was to evaluate the demographic data and complication rates in children who had undergone percutaneous endoscopic gastrostomy in a three-year period in our Division of Pediatric Gastroenterology and to interrogate parental satisfaction. Material and Methods: The demographic data, complications and follow-up findings of the patients who had undergone percutaneous endoscopic gastrostomy between March 2011 and March 2014 were examined retrospectively using medical files. Results: Forty seven percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrostomy related procedures were performed in 34 children during a three-year period. The median age of the patients was 2.25 years (3 months-16 years, first and third quartiles=1.0-6.0) and the mean body weight was 13.07±8.6 kg (3 kg-47 kg). Before percutaneous endoscopic gastrostomy procedure, the mean weight z score was -2.26±1.2 (-5-0) and the mean height z score was -2.25±0.96 (-3.85-0.98). The follow-up mean height and weight Z scores at the 12 th month after the percutaneous endoscopic gastrostomy procedure could be reached in 24 patients. A significant increase in the mean weight Z score from -2.41 to -1,07 (p=0.000) and in the mean height Z score from -2.29 to -1.99 (p=0.000) was found one year after percutaneous endoscopic gastrostomy catheter was placed in these 24 patients. Patients with neurological and metabolic diseases constituted the majority (64.7% and 26.5% respectively). Peritoneal leakage of food was detected in one patient and local stoma infections were detected in three patients after the procedure. During the follow up period, “Buried bumper syndrome” was observed in one patient. Following percutaneous endoscopic gastrostomy, the number of patients using anti-reflux medication increased from 16 (47.1%) to 18 (52.9%) (p=0.62). One patient with cerebral palsy who had aspiration pneumonia after percutaneous endoscopic gastrostomy insertion had undergone Nissen fundoplication. Percutaneous endoscopic gastrostomy tube was removed in a patient. The parents had positive views related with percutaneous endoscopic gastrostomy after the procedure. Conclusions: Percutaneous endoscopic gastrostomy is a substantially successful and reliable method in infants as well as in children and adolescents. The parents had positive views related with percutaneous endoscopic gastrostomy after the procedure. (Turk Pediatri Ars 2015; 50: 211-6)

Koagulaz Negatif Staphylococcus Aureus Sepsisine bagli Gelisen ve Perkutan Peritoneal Drenajla Tedavi Edilen Spontan Intestinal Perforasyonlu Ileri Derecede Dusuk Dogum Agirlikli Bir Yenidogan Vakasi Spontan intestinal perforasyon (SIP), nekrotizan enterokolitten (NEK) ayrilan bir klinik antitedir. SIP, en cok dusuk dogum agirlikli (VLBW) ve ileri derecede dusuk dogum agirlikli (ELBW) preterm infantlarda gorulur. Risk, VLBW infantlarda yaklasik olarak % 2-3, ELBW infantlarda ise % 5’dir. SIP icin en iyi bilinen tek risk faktoru prematuritedir (1-3). Biz, burada koagulaz negatif Staphylococcus aureus sepsisinine bagli oldugu dusunulen ve perkutan peritoneal drenajla tedavi edilen spontan intestinal perforasyonlu ileri derecede dusuk dogum agirlikli bir yenidogan vakasini sunmaktayiz.

Bochdalek hernisi diyaframdaki posterolateral defektten abdominal organlarin toraks bosluguna girmesi sonucu gelisen dogumsal bir hastaliktir. Gebeligin 8. haftasinda ploroperitoneal membranin septum transversum ile fuzyonundaki bozukluk sonucu olustugu dusunulmektedir. Defekt %70-90 sol taraftadir. Olgularin cogunlugu dogduktan sonra solunum sikintisi ile klinik bulgu verir ve eriskin yasa kadar semptomsuz seyir gostermesi oldukca nadir bir durumdur. Bu yazida, yirmi yasinda nefes darligi ve gogus agrisi sikâyetleriyle klinigimize gelen ve yapilan tetkiklerinde Bochdalek hernisi tanisi alan hastanin cerrahisi ve sonrasi takibinin anlatildigi bir olgu sunulmaktadir.

Objective To evaluate the clinical data and prognosis of cystic echinococcosis during a 5-year period who were followed by the pediatric clinics. Methods Demographic, clinical, laboratory, and prognosis data of 34 patients with cystic echinococcosis obtained between 2009 to 2014 were retrospectively evaluated. Of these, 10 patients were excluded because of incomplete data or failure to follow up. Results A total of 24 (12 males and 12 females) children were included the study. The mean ages of patients were 11.17 ± 3.71 (range, 5-17) years. The most common symptoms were abdominal pain (41.7%), cough (16.7%), and fatigue (12.5%). Localization of the parasite in the patients was determined to be as follows: liver (54.2%), lung (33.3%), and intraabdominal (4.2%). Multiorgan involvement was observed in 8.3% of the cases. Indirect hemagglutination test was positive in 13 (54.2%) patients at admission. All patients received treatment with albendazole. Seven patients were treated with puncture-aspiration-injection-re-aspiration (PAIR) (29.2%). Open surgery was performed in six patients (24.2%). One patient was treated with both PAIR and open surgery. Conclusions Cystic echinococcosis is a serious public health problem in developing countries. Hydatid cyst should be considered in the presence of suspicious radiological and clinical findings in endemic areas.

Accidental ingestion of caustic substances may cause serious problems in children. Approximately 20% of caustic ingestions result in esophageal stricture formation, resulting from excessive collagen synthesis to the extracellular matrix by fibroblasts. Recent studies showed that a single application of 5-fluorouracil (5-FU) is a very effective inhibitor of fibroblast proliferation and differentiation for prolonged periods. Using an experimental model, we investigated the efficacy of single-dose 5-FU on stricture formation after caustic esophageal burn.Forty Wistar-Albino rats were divided randomly into 4 equal groups: group 1 (sham-operated group), the esophagus was uninjured and untreated; group 2 (control group), the esophagus was injured and left untreated; group 3 (intraperitoneal treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraperitoneal dose (20 mg/kg) of 5-FU; group 4 (local treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraesophageal application of 5-FU at a concentration of 25 mg/mL. Caustic esophageal burn was produced by instilling 10% NaOH in the distal esophagus. The distal esophagi were harvested at 28 days postoperatively. Histologic sections were assessed by measuring the stenosis index (SI) and histopathologic damage score. Hydroxyproline (HP) levels in the tissues were determined biochemically.There were significant reductions in the SI (P.05), histopathologic damage score (P.05), and HP level (P.05) in the intraperitoneal treatment group when compared with the control group. No significant differences in the SI and histopathologic damage score were detected between the control and local treatment groups (P.05), whereas significant reduction in the HP level was determined between these groups (P.05).A single intraperitoneal dose of 5-FU had a preventive effect on stricture formation after caustic esophageal burn. This observation suggests that 5-FU may prevent this undesirable complication in the clinical setting. Clinical studies are now required to verify this form of treatment. Local intraesophageal application of 5-FU immediately after the burn injury was not effective. Further investigations are required to determine the appropriate timing of application of 5-FU at the local site of injury.

Choledochoduodenal fistula (CDF) is an unusual clinical entity and a diagnostic challenge in children. We herein present CDF as an unusual cause of recurrent cholangitis in a 6-year-old child. To the best of our knowledge, this is the youngest patient reported until date. In this paper, we also highlight possible etiologic factors, presenting symptoms, diagnostic methods, and treatment modalities of CDF.

Travma pediyatrik yaş grubunda en sık mortalite ve morbidite nedenidir. Baş ve ekstremitelerden sonra karın en sık yaralanan üçüncü bölgedir. Abdominal travmalar %8.5 gibi yüksek bir mortalite oranına sahiptir. Çocuklar anotomik, fizyolojik ve psikolojik yönlerden erişkinlerden farklılıklar gösterirler. Bu nedenle çocuklarda travmaya yaklaşım bazı farklılıklar göstermektedir. Bu yazıda, çocuklarda travma sonrası oluşan abdomen yaralanmalarının tipik klinik bulguları, değerlendirilmesi ve tedavisi anlatılacaktır.

Foreign body (FB) ingestion is a common condition in childhood. Most ingested FBs pass through the GI tract without any complication. Nevertheless, penetration of the intestinal tract is possible by sharp or pointed objects. Perforation may occur if such objects become lodged in a narrow segment of the GI tract. The morbidity depends on the continued route of the penetrating object and whether septic sequela ensue. 1 Although FBs may migrate to any intra-abdominal organ, perforation of the duodenum and migration into the liver are extremely rare. Only one case has been reported in the literature, in an adult woman. The pin was described in the liver, with the head of the pin in the lumen of the duodenum. In that case, the pin was removed laparoscopically. 2 Tothebestofourknowledge,wereportherethefirstpediatric case of an ingested pin that migrated from the duodenum into the liver. The pin was removed by flexible EGD by using a polypectomy snare, with the patient under general anesthesia. The patient tolerated the procedure well, without untoward effects.

Neonatal gastric volvulus (GV) is a rare clinical entity with a challenging diagnosis. In this study, we aimed to identify clinical and radiological findings to aid in early diagnosis in neonatal GV. The medical records of all neonates with GV were retrospectively reviewed. Diagnosis was made based on clinical findings and radiological images, and was documented by an upper gastrointestinal (UGI) contrast study. A total of eight neonates were included in the study. The most common clinical presentations were non-bilious vomiting and epigastric distention. The findings highly suggestive for GV in plain radiographs include gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium. GV should be suspected in any newborn with non-bilious vomiting and epigastric distention. It is also important to focus on the clues in the plain radiographs. Gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium must alert the physicians to the possibility of GV.

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm. It is a challenging disease because the symptoms and radiologic findings are diverse and nonspecific. Although pulmonary IMT is the most common form, pleural origin is an extremely rare clinical entity. Nuchal fibroma (NF) is another rare benign neoplasm. We report herein a case of pleural IMT with concomitant NF in a 15-year-old girl. To the best of our knowledge, this is the first report suggesting an association between IMT and NF, and our case had the largest reported intrathoracic IMT. Moreover, we found a possible association between IMT and increased CA-125 levels.

Ozpolat, Berkant/0000-0002-6203-7306 WOS: 000321798900027 Background: This study aims to investigate the efficacy and safety of different doses of iodopovidone for pleurodesis and to evaluate the histopathological changes in thyroid tissue. Methods: Thirty-eight male Albino Wistar rats (260-320 g, 6-8 months old) included in this experimental study were randomly divided into four groups. Groups 1, 2, and 3 were given 2 mL/kg intrapleural iodopovidone at concentrations of 1%, 2%, 4%, respectively, while group 4 was administered intrapleural saline. The surfaces were graded by macroscopic and microscopic examination on Day 30 and thyroid tissues were histopathologically examined. Results: Iodopovidone at concentrations of 2% and 4% resulted in significantly more adhesions and inflammatory response. Four percent iodopovidone produced nonsignificant microscopic changes in the contralateral visceral pleural surface. No vacuolization in thyroid tissue showing hyperthyroidism was observed in the groups. Conclusion: We suggest that 2% iodopovidone is enough for an effective and safe pleurodesis and the concentration of iodopovidone may be raised to 4% in unsuccessful cases. However, as the study was conducted on rats, it still remains to be elucidated that the similar results can be achieved in human studies.

Placement of ventriculoperitoneal(VP) shunt is a worldwide accepted procedure for treatment of hydrocephalus. This procedure have various intra-abdominal complications, of which pseudocyst formation is a rare one. Common presentations of this complication are abdominal mass, abdominal pain, intestinal obstruction, and shunt dysfunction. In this paper, we report a case of 3 year-old boy with cerebrospinal fluid (CSF) pseudocyst of the VP shunt presenting with hyponatremic seizure. To the best of our knowledge, hyponatremic seizure has not been previously reported as a presentation of abdominal CSF pseudocyst in the literature. Our case has also the largest CSF pseudocyst with respect to body surface area of the child in the literature.

Bile-plug syndrome is defined as an obstruction of the common bile duct by bile sludge in full-term infants. It is a correctable cause of obstructive jaundice in infants and is generally treated surgically. Here, we present a case of a 5-month-old infant with bile-plug syndrome, which was treated by percutaneous biliary interventions. To the best of our knowledge, percutaneous treatment of bile-plug syndrome is reported for the first time in an infant. This minimal invasive treatment modality may be a useful alternative to surgery in infants with bile-plug syndrome.

We designed an open-labeled, prospective, randomized, controlled clinical trial to test the efficacy of topical lanolin ointment (PureLan) and bovine type I collagen spray (Gelfix) in the treatment of childhood anal fissures.Seventy-one children with acute anal fissure were divided randomly into three groups: group I (control; n = 25), group II (PureLan; n = 28), and group III (Gelfix; n = 18). All children were assigned to have warm sitz baths, topical analgesic creams, and stool softeners. Patients in groups II and III were also treated with topical lanolin ointment and bovine type I collagen, respectively. All children were re-examined 4 weeks later.Complete healing of the anal fissure was observed in 68% of the group I patients, but in 92.9% and 100% of the group II and III patients, respectively. The difference among groups was significant in terms of complete fissure healing (P = 0.003), but the efficacy of topical lanolin ointment and bovine type I collagen spray did not differ significantly (P = 0.078).Our data suggest that topical lanolin ointment and bovine type I collagen spray are effective in the treatment of acute anal fissure in children.

Percutaneous endoscopic gastrostomy (PEG) is an easy and safe procedure for long-term enteral feeding in children with inadequate oral intake. Although PEG has been used for treatment of gastric volvulus in adults, there is a little relevant data for its use in children. Here, we report a 17-month-old male infant who was admitted to our hospital with a 1-month history of vomiting. Upper gastrointestinal contrast study revealed an organoaxial gastric volvulus. Then PEG was inserted for the purpose of nutritional support. Because the patient continued to vomit after feeding via gastrostomy, surgery was planned. Laparotomy revealed that the entry of the PEG tube was at the posterior wall of the stomach. The gastrostomy tube was removed, and the opening was repaired. Then the stomach was repositioned, and Nissen fundoplication and a Stamm gastrostomy at the anterior wall of the stomach were performed. The patient had no further episodes of vomiting after surgery and was discharged following an uneventful recovery period.

Klippel-Trenaunay syndrome is a rare congenital disorder characterized by combined vascular malformations, varicosities, and limb enlargement. A child case of Klippel-Trenaunay syndrome with a large cervicomediastinal cystic lymphatic malformation and a vascular mass on the chest wall has been presented to demonstrate combined use of conservative and surgical approaches in this syndrome. Cystic lymphatic malformation was treated by sclerotherapies including ultrasound-guided transthoracic bleomycin injection into mediastinal cyst, which was tried for the first time in the literature, and vascular chest wall tumor necessitated surgical excision.

Amaç: Hipospadiyas ve interseks olgularında prostatik utrikül (PU) sıklığı, klinik karakteristikleri, tedavi metodları ve izlem sonuçlarını değerlendirdik.Gereç ve Yöntem: Hipospadiyas (n:72) ve interseks (n:108) tanılarıyla tedavi edilen, radyolojik ve endoskopik incelemelerle PU varlığı araştırılan hastalar retrospektif olarak incelendi. Bulgular: PU sıklığı hipospadiyas olgularında %12.5, interseks olgularında ise %22.2 bulundu. Her iki grupta en sık görülen klinik semptomlar üriner enfeksiyon, üriner obstrüksiyon, enürezis ve ürolitiyazisdir. Sonuç: İnterseks ve ağır hipospadiyas olgularında PU varlığı radyolojik ve endoskopik yöntemlerle araştırılmalıdır. Cerrahi tedavide ana amaç üretra, mesane boynu, sfinkterler ve pelvik sinir ağına zarar vermeden, büyümüş PU yapılarının tümüyle çıkartılmasıdır.