Systematic Review and Meta-Analysis on the Influence of Surgeon Specialization on Outcomes Following Appendicectomy in Children.

The aim of this study is to assess the influence of surgeon specialization on outcomes following appendicectomy in children.General surgeons and pediatric surgeons manage appendicitis in children; however, the influence of subspecialization on outcomes remains unclear.Two authors searched Medline and Embase to identify relevant studies. Eligible studies were comparative and provided data on children who had appendicectomy while under the care of general or pediatric surgical teams. Two authors initially screened titles and abstracts and then full text manuscripts were evaluated. Data were extracted by 2 authors using an electronic spreadsheet. Pooled risk ratios and pooled mean differences were used in analyses.We identified 9 relevant studies involving 50,963 children who were managed by general surgery teams and 15,032 children who were managed by pediatric surgery teams. A normal appendix was removed in 4660/48,105 children treated by general surgery units and in 889/14,760 children treated by pediatric units (pooled risk ratio 1.79; 95% confidence interval [CI] 1.26-2.54; P = 0.001). Children managed in general units had shorter mean hospital stays compared with children managed in pediatric units (pooled mean difference -0.70 days; 95%CI -1.09 to -0.30; P = 0.0005). There were no significant differences regarding wound infections, intra-abdominal abscesses, readmissions, or mortality.We found that children who were managed by specialized pediatric surgery teams had lower rates of negative appendicectomy although mean length of stay was longer. Our article is based upon a group of heterogeneous and mostly retrospective studies and therefore there is little external validity. Further studies are needed.

Adult intussusception caused by myoepithelial hamartoma in the small bowel: A case report.

INTRODUCTION: Intussusception is rare in adults and can have acute, intermittent or chronic presentations. We present an unusual case of intussusception in an adult. PRESENTATION OF CASE: A 25 year old male presented with sudden severe abdominal pain and vomiting. He had no relevant medical history. Mechanical small bowel obstruction was confirmed on imaging and laparotomy revealed a nodular lead point in the submucosa of the ileum. He had resection of a segment of small bowel with a primary anastamosis. Histopathology of the lesion demonstrated myoepithelial hamartoma (MEH), a rare cause of intussusception. DISCUSSION: Although intussusception is not uncommon in children, it is rare in adults. Management delays are a major cause of morbidity. This report details our management of a case of intussusception caused by MEH in an otherwise healthy adult. CONCLUSION: Intussusception caused by MEH is a rare but serious cause of mechanical bowel obstruction. We propose that surgeons should consider this diagnosis in atypical cases of bowel obstruction and expedite laparotomy when it is suspected.

Ileocecal lipohyperplasia presenting as a chronic sideropenic anaemia.

Ileocecal lipohyperplasia is a relatively uncommon pathological entity characterised by submucosal infiltration of adipose tissue in the ileocecal valve (ICV). The majority of patients are asymptomatic, whereas, others present with serious complications. We report a 45-year-old man who presented with recurrent episodes of melena with secondary sideropenic anaemia for 6 years. Extensive radiological and endoscopic workup failed to detect the source of bleeding. During his last admission for abdominal pain, contrast-enhanced CT scan revealed a fatty mass at the ICV. The patient underwent limited right hemicolectomy, and histology confirmed ileocecal lipohyperplasia. The patient remained well 18 months later. This case highlights the difficulties encountered by clinicians in diagnosing this unusual colonic pathology.