Journal of pediatric surgery
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Randomized Controlled Trial Comparative Study
An evidence-based definition for perforated appendicitis derived from a prospective randomized trial.
Appendicitis is the most common urgent condition in general surgery, and yet there is no evidence-based definition for perforation. Therefore, all retrospective data published on perforated appendicitis are unreliable because of an ill-defined denominator. For approximately 2 years beginning in April 2005, we performed a prospective randomized trial investigating 2 different antibiotic regimens for perforated appendicitis. During this study, we strictly defined perforation as a hole in the appendix or a fecalith in the abdomen. Before this prospective study, perforation was staff surgeon opinion. We investigated the abscess rates in both the perforated and nonperforated appendicitis populations before and during the study to determine if our definition was safe and that there was not an increased risk of abscess formation in patients treated as nonperforated. ⋯ Defining perforation as a hole in the appendix or a fecalith in the abdomen is effective in identifying the patients at risk for postoperative abscess formation. Application of these criteria would allow substantial reduction in therapy for patients with purulent or gangrenous appendicitis who do not possess the same abscess risk. These data outline the first evidence-based definition of perforation.
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Review Case Reports
Prolapse of the rectum associated with spontaneous rupture of the distal colon and evisceration of the small intestine through the anus in an infant.
Prolapse of rectum of varying degrees is a well-known entity in children. Spontaneous rupture of the rectum along with massive ileal evisceration because of increased intraabdominal pressure is a rare complication of rectal prolapse in the adults. ⋯ Known complications of the rectal prolapse in children include recurrent mucosal ulceration, bleeding, and proctitis. Spontaneous rupture of the rectum with or without ileal evisceration has not been previously reported in infants.
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An intraluminal pyloric duplication cyst is an extremely rare congenital anomaly. We report a case of an intraluminal pyloric duplication cyst in a 2-year-old girl with progressive increased vomiting. ⋯ The diagnosis was confirmed by surgery and histopathologic examination. The patient was asymptomatic at the 12-month follow-up.
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Recombinant activated factor VII (rFVIIa) is infrequently used off-label in infants despite a paucity of data in this population. We report a retrospective review of rFVIIa use in infants focusing on safety and efficacy. ⋯ This is the first large case series demonstrating the efficacy of rFVIIa in critically ill infants with active hemorrhage by reducing their transfusion requirements. Furthermore, venous thrombosis was not associated with increase in either the number of doses or dosage of rFVIIa.
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Intussusception is a frequent cause for bowel obstructions and pediatric surgical consults. First described by Barbette in 1674, the etiology and treatment of intussusception has undergone several revisions for the last 300 years. Currently, we understand most intussusceptions in young children to be of idiopathic in nature with the incidence of pathologic lead points increasing with the age of the child. Although both Meckel's diverticulum and duplication cysts have both been reported numerous times in the past as a source of a lead point, we report, to our knowledge, the only case of both found in a child requiring operative reduction.