Journal of pediatric surgery
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Traumatic splanchnic artery pseudo-aneurysms are uncommon; only two cases have been reported among the pediatric population. The authors describe their experience with four patients in whom splanchnic artery pseudoaneurysms developed after blunt abdominal trauma. Splenic artery pseudo-aneurysms were found in a 6-year-old boy and an 8-year-old girl after blunt splenic injuries. ⋯ All four children have recovered completely, with no long-term sequelae. Traumatic splanchnic artery pseudo-aneurysms are potentially life-threatening complications that can occur after blunt abdominal trauma. The investigation and management of these lesions must be individualized according to the clinical scenario.
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To determine the sensitivity, specificity, and positive and negative predictive values of the computed tomography (CT) scan in the diagnosis of clinically significant intestinal and mesenteric injury in pediatric blunt abdominal trauma. ⋯ The CT scan is an excellent test to screen for clinically significant intestinal and mesenteric injury in pediatric patients with blunt abdominal trauma. Because of the lower positive value, other clinical and diagnostic imaging information may help to improve diagnostic accuracy. Most importantly, CT rarely misses a significant intestinal or mesenteric injury.
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Since 1980, the authors have not routinely removed an appendix on an interval basis after treatment of a ruptured appendiceal mass (phlegmon and/or abscess). In the present group of patients, there were eight boys and two girls, two to 15 years of age (mean, 8.5 years). All presented with symptoms and signs typical of ruptured appendix, with a mass suspected by history and examination, and proven by radiological means (usually ultrasonography). ⋯ One child (2 years old) returned in 2 months with symptoms and signs of a ruptured appendix, and appendectomy was performed. The other nine have remained well, for 6 months to 13 years. From this experience and a review of the literature, only a relatively small number of patients with a properly treated ruptured appendiceal mass (phlegmon and/or abscess) will return with a flareup (recurrence) of appendicitis (requiring appendectomy); the rest live a normal life, with their asymptomatic appendix intact.