Journal of pediatric surgery
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A 12-year-old girl presented with lower abdominal pain, nonbilious vomiting, and a severe secretory diarrhea. Infectious and noninfectious etiologies were ruled out, and she was found to have perforated acute appendicitis. It is essential to consider acute appendicitis in the differential diagnosis for secretory diarrhea and abdominal pain in the pediatric population.
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Controversy surrounds the justification of a second course of extracorporeal membrane oxygenation (ECMO) for patients that deteriorate after initial decannulation. The authors' experience with a small number of patients requiring recannulation led them to investigate the results of a second ECMO course from all institutions that report to the ELSO registry. ⋯ A small subset of patients may require recannulation and a second ECMO course. Although survival may be achieved in more than one third of these patients, complication rates are increased during the second course. Specifically, neurologic, infectious, renal, and metabolic complication rates are increased. Long-term consequences of recannulation are unknown. Selection criteria identifying patients that may benefit from recannulation have not been established.