Appendicitis in Children: Does Age Really Matter?

BACKGROUND: Acute appendicitis (AA) is a frequent and emergent surgical abdominal condition that presents some particularities and challenges in young children. PATIENTS AND METHODS: Data of 402 children aged <16 years with a confirmed diagnosis of AA were retrospectively reviewed. Included patients were divided into two groups: Group A (preschool children aged ≤5 years, n = 44) and Group B (school children aged >5 years, n = 358). Clinical presentation, biological findings, calculated diagnosis scores (paediatric appendicitis score [PAS] and Alvarado score), intraoperative findings and outcomes were comparatively analysed between the two groups. RESULTS: Children of Group A had more likely fever, bowel disorders, diffuse abdominal pain and diffuse tenderness than those of Group B (P = 0.001, P = 0.005, P = 0.006 and P = 0.001, respectively). Regarding biomarkers, the mean of white blood cell count and C-reactive protein levels was higher in Group A than in Group B (18,849 cell/mm3 and 162.8 mg/L in Group A versus 15,938 cell/mm3 and 86.7 mg/L in Group B, P = 0.003 and < 0.001, respectively). The mean of calculated PAS and Alvarado scores was higher in Group A than in Group B (8.2 ± 1.1 and 8.2 ± 1 vs. 7.5 ± 1.4 and 7.4 ± 1.5, P = 0.003 and P = 0.001, respectively). Most children with a calculated PAS and Alvarado score equal to or higher than 8 belonged to Group A (PAS: 84.1% vs. 58.4%, P = 0.001, Alvarado score: 84.1% vs. 55.6%, P < 0.001). The perforation of the appendix was seen in 77.3% of Group A patients and only in 41.5% of children in Group B (P < 0.0001). The mean length of stay was 5.1 ± 1.9 days in Group A and 4.3 ± 2.8 days in Group B but without any statistical difference between the two groups (P = 0.094). CONCLUSION: AA in preschool children is associated with atypical presentation and rapid progression of the disease making the early diagnosis mostly challenging in our settings.

Compartment Syndrome: An Uncommon Twist in Childhood Henoch-Schönlein Purpura.

Henoch-Schönlein purpura (HSP) also known as rheumatoid purpura is the most common vasculitis in children. This condition affects small blood vessels, predominantly targeting the skin, digestive system, joints, and kidneys. Short-term prognosis mainly depends on abdominal complications, while long-term prognosis is mainly determined by the severity of kidney involvement, which occurs in about 35% of cases. Although uncommon, other organs such as the lungs, heart, or nervous system may also be affected. Compartment syndrome of the hand and forearm is a very rare complication of HSP. To our knowledge, only two cases have been reported in the literature. We describe the case of a four-year-old child who presented with rheumatoid purpura complicated by compartment syndrome of the hand and forearm successfully managed through emergency fasciotomy.

Surgical management of ovarian masses in children and adolescents: experience of an academic institution in France.

PURPOSE: Surgical management of ovarian masses in girls still challenging. The aim of the study is to report an 8-year experience in managing children with ovarian masses, and to demonstrate the advantages and the limitations of laparoscopy for such lesions. METHODS: Data of girls aged less than 18 years operated because of an ovarian mass between January 2015 and February 2023 were retrospectively reviewed. Patients were divided into two groups: group A including children operated by laparoscopy, and Group B of patients who underwent open surgery. RESULTS: Eighty-eight children were enrolled. Laparoscopy was performed in 56 patients (63.6%). Group A patients had smaller tumor size (53.6±38.5 vs. 122.2±75.4 mm, P<0.0001), shorter operative time (50.4±20.3 vs. 71.5±36.5 min, P = 0.004), reduced length of hospital stay (1.4±1.1 vs. 3±2.3 days, P<0.0001), and absence of postoperative complications. Only 3 cases (5.7%) of recurrence were seen exclusively within patients followed for benign tumors during a mean follow-up period of 4.6±3 years. CONCLUSION: Laparoscopy should be done in benign ovarian lesions or/and if a torsion is seen. For tumors at high risk of malignancy, laparoscopy can be performed to establish a clear macroscopic diagnosis, for staging of the disease, and resection of small tumors. Conversion to open surgery is indicated in case of doubt.

Femur Fracture With Arterial Injury in an 11-Year-Old Boy: A Case Report of a Rare Association.

Post-traumatic vascular lesions of the lower extremity in children are uncommon and present some particularities in their management in comparison to those that occur in adults. Here, we report the case of an 11-year-old boy who presented with a diaphyseal fracture of the right femur associated with an injury of the homolateral superficial femoral artery after blunt trauma of the lower limb. The bone and the arterial injuries were surgically and successfully treated by an elastic stable centromedullary nailing and a venous bypass, respectively, with a good clinical and radiological evolution. The management of vascular injuries in childhood can be challenging and requires some special measures to avoid undesirable complications. Functional prognosis is generally described to be good if a rapid and adequate treatment is performed.

Soft tissue chondroma of the plantar foot in a 14-year-old boy: a case report.

INTRODUCTION AND IMPORTANCE: Soft tissue chondroma is a rare benign tumor with a predilection for hands and feet. The incidence is only about 1.5% of all benign tumors and this neoplasm is rarely seen in the paediatric population. In this paper we report the case of a 14-year-old boy treated for a soft tissue chondroma located next to the left foot second metatarsal. CASE PRESENTATION: A 14-year-old boy presented with a slowly growing plantar swelling of the left foot. The mass was solid, mobile, measuring 4 cm and located in soft tissues opposite of the left foot second metatarsal. Magnetic resonance imaging was performed and revealed a mass measuring 37 ∗ 27 mm with regular seams, on iso-signal T1 and hyposignal T2 without any skeletal connection. A marginal excision of the mass was performed and the postoperative time was uneventful. CLINICAL DISCUSSION: The clinical presentation of soft tissue chondroma is generally not specific which makes the diagnosis mostly challenging. Magnetic resonance imaging is the most performed paraclinical examination that allows a better analysis of the lesion. A surgical excision of the tumor is the treatment of choice. CONCLUSION: Soft tissue as a primary site of chondroma is a rarely reported localisation and this neoplasm should be kept in mind as a possible diagnosis face to any plantar mass in childhood.

An Unusual Presentation of Hydatid Disease in a Child: A Case Report.

The subcutaneous localization of the hydatid cyst in the abdominal wall is rarely encountered particularly in the pediatric population and is sometimes difficult to diagnose preoperatively. Here, we report the case of a 6-year-old boy who presented with two isolated episodes of low abundant hemoptysis and in whom a mass on the right lumbar region already considered as a lipoma was studied. Laboratory and radiological examinations were requested and the parietal cyst was surgically managed. The macroscopic and the pathological examination confirmed the diagnosis of the hydatid disease and helped in identifying the nature of the thoracic lesion that disappeared spontaneously after two episodes of hydatid vomiting. Hydatid cyst should be considered as a diagnosis for any masses of the abdominal wall. Moreover, biopsy and partial resection of the mass must be avoided.

Mixed ovarian germ cell tumor in a child: A case report of a rare association.

INTRODUCTION AND IMPORTANCE: ovarian tumors and especially mixed ovarian germ cell tumors are rarely seen in the paediatric population. CASE PRESENTATION: we report the case of a 13-year-old girl which was successfully treated for a mixed ovarian germ cell tumor with a favorable evolution. CLINICAL DISCUSSION: the incidence of mixed ovarian germ cell tumors, clinical manifestations, histologic distribution and prognosis are predominentely distinct in children and adolescents as compared to adult population. The diagnosis should be suspected in young girls with chronic abdominal pain and palpable swelling of the lower abdomen. Conservative surgery is the first therapeutic procedure that consists of a total resection of the mass with preservation of the reproductive function. Circulating tumor markers have the potential in diagnosis, prognostic stratification and for follow-up. CONCLUSION: mixed ovarian germ cell tumors are uncommen in children. Their management must be multidisciplinary and conservative surgery by laparotomy represent the standard of care.