Hepatic Cystic Echinococcosis (Hydatid Cyst) in a Six Year Old.

Presentation To describe a case of cystic echinococcosis (CE) in a previously healthy child and review epidemiology of CE in Ireland. Diagnosis A previously healthy 6 year old girl was found to have a cystic lesion in the right lobe of her liver. Serology for Echinococcus granulosus was positive, and radiological features were suggestive of CE. Treatment The patient was pre-treated with anti-helminthic medications before undergoing a liver segmentectomy to remove the cyst, and received further treatment with albendazole after surgery. Histological findings were consistent with CE due to E. granulosus, likely acquired during travel to continental Europe. Conclusion CE should be considered in the differential of children with asymptomatic cysts in the liver and/or lung, and a travel history elucidated in such cases.

Trends in the Use of Laparoscopic Versus Open Paediatric Appendicectomy: A Regional 12-Year Study and a National Survey.

BACKGROUND: In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls. METHODS: A retrospective case-control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons. RESULTS: Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0-1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0-9 years); 65, 1% (10-13 years); 71, 2% (14-16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg. CONCLUSION: The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.

Associated urological anomalies in children with unilateral renal agenesis.

PURPOSE: Unilateral renal agenesis has been noted in 1:1,000 autopsies. Recently an increased incidence of vesicoureteral reflux was reported in patients with a solitary kidney. We determined the incidence of associated renal abnormalities in children with unilateral renal agenesis. MATERIALS AND METHODS: We retrospectively reviewed 46 consecutive cases of unilateral renal agenesis diagnosed at our hospital between January 1985 and February 1998. Patient age at diagnosis ranged from newborn to 12.5 years (mean 2.8 years). There were 24 boys and 22 girls. The left kidney was absent in 27 patients and the right kidney was absent in the remaining 19. A total of 24 patients were evaluated for urinary tract infection and in the other 22 a solitary kidney was found during examination for congenital malformations, enuresis or abdominal pain. The diagnosis was made in all patients by abdominal ultrasound and confirmed by excretory urography, or diethylenetriaminepentaacetic acid or dimercapto-succinic acid scan. A voiding cystourethrogram was performed in 40 patients (87%). RESULTS: Associated urological anomalies were present in 22 of the 46 patients (48%) with unilateral renal agenesis, including primary vesicoureteral reflux in 13 (28%), ureterovesical junction obstruction in 5 (11%), ureteropelvic junction obstruction in 3 (7%), and ureterovesical and ureteropelvic junction obstruction in 1 (2%). Of the 22 patients 14 (64%) underwent surgical intervention. CONCLUSIONS: Nearly half of the patients with unilateral renal agenesis had associated urological anomalies. Vesicoureteral reflux was the most common associated anomaly and it was usually of high grade. Early recognition and treatment of urological anomalies in a patient with a solitary kidney are imperative to decrease the long-term risk of renal damage.