Laparoscopy diagnosis and treatment excision of bleeding Meckel's diverticulum in a child: report of one case.

Meckel's diverticulum is a common cause of low gastrointestinal bleeding in childhood. Conventional diagnostic methods including plain abdominal radiographs, abdominal ultrasound, technectium 99m pertechnetate scintigraphy, angiography, and exploratory laparotomy have several limitations. Here, we report that a case of Meckel's diverticulum in a 1-year-7-month-old boy presenting with intermittent episodes of painless low gastrointestinal bleeding for about one year. Despite the traditional studies, including plain abdominal films, abdominal ultrasound, rectosigmoidoscopy and repeated Tc-99m Meckel's scan, all showed negative finding, it was successfully diagnosed along with excision of Meckel's diverticulum by laparoscopy. The patient made a rapid recovery and discharged at 48 hours after the procedure. We emphasize that laparoscopy should be an alternative diagnostic and therapeutic modality of choice in patients suspected of Meckel's diverticulum, especially in pediatric patients who had negative results of all other work-ups.

Evaluation of a streptococcal pharyngitis score in southern Taiwan.

BACKGROUND: Group A streptococcus (GAS) pharyngitis can cause serious complications such as rheumatic heart disease. The McIsaac sore throat score is a clinical prediction score used to improve the detection rate of GAS pharyngitis. We evaluated the validity of the McIsaac sore throat score in Southern Taiwan and compared our findings to those of other studies. METHODS: We retrospectively analyzed chart records from children aged 3 to 15 years old who complained of fever and sore throat. They had throat cultures collected at the outpatient pediatric clinic of Fooyin University Hospital, located in Pingtung County, Taiwan during the period between January 2007 and January 2010. Clinical characteristics were reviewed, and sore throat score was analyzed. RESULTS: A total of 342 throat cultures met the inclusion criteria of sore throat and fever. The positive rate of GAS was 4.1%. Culture-positive cases were associated with higher odds for a skin rash [adjusted odds ratio (AOR): 14.66, 95% confidence interval (CI): 4.63-46.40, p < 0.001), lower odds for cough (AOR: 0.19, 95% CI: 0.04-0.85, p = 0.030) and having a runny nose (AOR: 0.22, 95% CI: 0.05-0.99, p = 0.048). The most common physical sign was scarlet fever rash (AOR: 57.35, 95% CI: 15.45-212.98, p < 0.001). A McIsaac score of 5 had a sensitivity of 71%, specificity of 70%, and a positive predictive value of only 9.3%. CONCLUSION: Pediatric streptococcal pharyngitis in Southern Taiwan is uncommon. Diagnosis of GAS pharyngitis based on the McIsaac sore throat score is unreliable among pediatric patients with febrile pharyngitis in Southern Taiwan.

Ectopic pelvic kidney with urinary tract infection presenting as lower abdominal pain in a child.

Ectopic pelvic kidney is a rare developmental anomaly. Ectopic pelvic kidney can present without the characteristic symptoms associated with the urinary tract pathology. Ectopic pelvic kidney is usually unknown, and nonspecific vague abdominal comfort maybe the only symptom. Early detection and recognition of an ectopic kidney can prevent long-term complications. We report a 3-year-5-month-old girl with ectopic pelvic kidney who experienced intermittent episodes of lower abdominal pain for about 1 month. Abdominal ultrasound, computed tomography, and intravenous pyelography demonstrated a pelvic kidney. Thereafter, the urinalysis showed pyuria (white blood cell 20/high power field), and urine culture grew Escherichia coli. We emphasize that pelvic kidney should be considered in patients presenting unexplained vague abdominal pain, especially in pediatric patients who had intermittent recurrent episodes.

Factors contributing to prolonged hospitalization of patients with infantile hypertrophic pyloric stenosis.

BACKGROUND: To study the influence of clinical audit on diagnosis, complications, and factors contributing to hospitalization of patients with infantile hypertrophic pyloric stenosis. STUDY DESIGN: Retrospective cohort study. METHOD: There were 214 patients from 1991 to 2004 from three medical centers in Kaohsiung. Data were analyzed with respect to diagnostic methods, complications, and factors requiring patient hospitalization. RESULTS: The ratio of male to female was 4.8:1 (177 males and 37 females). The diagnoses before admission were as follows: 22% had milk intolerance and 14.5% had esophageal reflux. There was a significant increase in the use of sonogram diagnostic test (p=0.005) and a decrease in the incidence of diagnosis by olive mass palpation but not by barium meal test. Surgery time of 48 hours after admission was significant with barium meal examination and related to longer hospital stay (p<0.001). Weight gain less than 800 g before admission (n=125) was related to longer hospital stay (p=0.026). CONCLUSION: The diagnostic method was changed from olive mass palpation to sonogram. Weight gain less than 800 g before admission and surgery time of 48 hours after admission were related to longer hospital stay.

Infantile hepatic hemangioendothelioma presenting as early heart failure: report of two cases.

Hepatic hemangioendothelioma is rare. We report on hepatic hemangioendotheliomas in 2 young infants, with initial manifestations of respiratory distress and congestive heart failure. Serum alpha-fetoprotein (alphaFP) level was as high as 26,343 microg/l at 14 days old in 1 case, but was only 18 microg/l in the other case. The 2 patients were treated with prednisolone and hepatic artery ligation, respectively, with no residual sequelae after 12 months of follow-up. In this article, the clinical courses of these 2 young infants are reviewed, and the management of infantile hepatic hemangioendothelioma complicated with heart failure is discussed. In our experience, early heart failure caused by infantile hepatic hemangioendothelioma can be well controlled, especially with prednisolone therapy or by hepatic artery ligation. Spontaneous regression has been reported. However, without early recognition and therapeutic intervention, progression to decompensated heart failure may lead to death. Furthermore, it is necessary to differentiate infantile hepatic hemangioendothelioma (IHH) from hepatic malignancies.

Adenocarcinoma of the colon in children presenting as abdominal pain: report of two cases.

Adenocarcinoma of the colon is an unusual disease in patients under 30 years of age, and generally presents as advanced disease because of a lack of awareness of its occurrence, especially in the pediatric age group. The authors report on 2 cases of colon cancer in children less than 17 years old, whose initial presentations were abdominal pain of unclear etiology and non-specific abdominal complaints. No other abnormal laboratory results were found except that 1 patient had anemia. Barium studies revealed the typical colon lesions in both patients, and colonoscopic pathologic examination disclosed mucinous adenocarcinoma. The first patient was rather unusual in that 2 separate tumors were found simultaneously in the large intestine. The therapeutic approach included surgery and adjuvant chemotherapy, but both patients ultimately died due to poor response and early recurrence. Survival obviously depends on the extent of the disease at diagnosis; the earlier the diagnosis is, the better the prognosis will be. Clinical characteristics, diagnosis, and treatment of colon cancer in pediatric patients are discussed.